When we try to meet a doctor, undergo procedure the first step all of prefer to do would be to talk to the doctor, medical center, physician office to make sure the procedure is in-network. Primary reason is to save money on deductible, out-of-pocket maximums and make some sense of insurance premiums paid. If the doctor or facility happens to be out-of-network and we have no other way to go are we in catch 22 situation?
Based on our recent personal experience, we would like to share our experience so that our readers can benefit and save money in their upcoming visits, procedures etc
1) We went to our general physician and a situation demanded us to have the treatment done by specialist
2) Upon calling specialist office we found that he is out-of-network. They refused to consider ou case as in-network
3) Not knowing what to do, we called our insurance provider and explained out situation
4) The customer representative connected us to special care team that does take care of specialty services
5) She took details of the specialist with whom we had our appointment scheduled
6) Health insurance companies deal with situations like this following the steps
6.1) They check and make sure there are no in-network specialist in our area within 30 miles (It depends on your health insurance talk to them)
6.2) They communicate this to the benefits department of our employer to see if this can be made in-network.
TIP# We spoke to our benefits department directly and found that they can't do anything about it. However, when such request comes through your health insurance provider they treat it differently. So, have your insurance provider contact your benefits rather than you contacting them directly
7) We got an approval from our health insurance provider saying that our case has been approved
This does not stop here. Now, this needs to be communicated to the specialist facility. This will not be automatic. We should have the health insurance provider contact the specialist doctor and let them know that they are going to process it in-network. This is important because most out-of-network doctors at times miss to submit the bill and you might end up paying full amount. So, make sure you, insurance provider, your benefits department, your out-of-network doctor or facility are all on same page. Good luck with your money saving in upcoming health visit
Based on our recent personal experience, we would like to share our experience so that our readers can benefit and save money in their upcoming visits, procedures etc
1) We went to our general physician and a situation demanded us to have the treatment done by specialist
2) Upon calling specialist office we found that he is out-of-network. They refused to consider ou case as in-network
3) Not knowing what to do, we called our insurance provider and explained out situation
4) The customer representative connected us to special care team that does take care of specialty services
5) She took details of the specialist with whom we had our appointment scheduled
6) Health insurance companies deal with situations like this following the steps
6.1) They check and make sure there are no in-network specialist in our area within 30 miles (It depends on your health insurance talk to them)
6.2) They communicate this to the benefits department of our employer to see if this can be made in-network.
TIP# We spoke to our benefits department directly and found that they can't do anything about it. However, when such request comes through your health insurance provider they treat it differently. So, have your insurance provider contact your benefits rather than you contacting them directly
7) We got an approval from our health insurance provider saying that our case has been approved
This does not stop here. Now, this needs to be communicated to the specialist facility. This will not be automatic. We should have the health insurance provider contact the specialist doctor and let them know that they are going to process it in-network. This is important because most out-of-network doctors at times miss to submit the bill and you might end up paying full amount. So, make sure you, insurance provider, your benefits department, your out-of-network doctor or facility are all on same page. Good luck with your money saving in upcoming health visit
