Posts Tagged ‘out-of-network’

Out-of-Network Insurance Costs Can Be Sky High

Tuesday, March 18th, 2014

Unless you’re made of money, it’s really important to pay attention to the health care providers you see.  In-network and out-of-network may just seem like insurance terms, but if you you make the decision to seek health care that is out of the network established by your health insurance plan, you might end up paying a lot of money out of pocket.  In the Kaiser Health News article, “Warning: Opting Out Of Your Insurance Plan’s Provider Network Is Risky,” Michelle Andrews gives us the run down on what to expect out-of-network.  There are a lot of health insurance plans, especially in the new health insurance marketplaces, that offer consumers lower premium costs if they choose a network of health care providers that is more limited.  Some people opt for these plans with the assumption that they will simply go out-of-network if necessary and pay the added costs.  They may not know just how much those added costs will be though.

The Affordable Care Act has put limits on the out of pocket costs that Americans will have to pay each year.  For 2014, the limits are $6,350 for individuals and $12,700 for families.  These maximum out of pocket costs are only for in-network care though.  Most health insurance plans can charge you much more if you go out-of-network.  Some companies don’t even have a cap on your out of pocket costs when you go out-of-network.  Annual check-ups, vaccines, cancer screenings and other preventative care are now free for most Americans with health insurance plans.  But if you choose to receive these services from a provider out of your network, you will likely pay for these otherwise “free” services.  Health insurance companies often charge consumers higher co-payments and coinsurance for care that they receive out of their network.  In addition to that, doctors and hospitals can charge you what is known as “balance billing” when they are out of your insurance company’s network.  Since they aren’t in a contract with your insurer, many out of network doctors and hospitals will send you a bill for any charges that your insurance did not cover.

This in-network versus out-of-network cost structure holds true for Americans who purchased health insurance through the marketplaces, those with individual health insurance plans, and even workers who receive health insurance plans through their employer.  You would be hard pressed to find a health insurance plan that covers care at any doctor or hospital.  The four levels of plans in the health insurance marketplace are bronze, silver, gold and platinum.  They cover 60, 70, 80 and 90% of your medical services, respectively.  But those percentages only account for in-network care, something you have to keep in mind when choosing providers.  When taking a look at the silver plans specifically, 70% of them are considered narrow network, which means that 30% of the largest hospitals in your area will not be in-network.  With ultra narrow network plans, 70% of the largest hospitals in your area are out-of-network.  Emergency care will be covered because of a stipulation in the health care law, regardless of where you receive care.  Insurance companies cannot charge you higher co-payments or coinsurance if you are out-of-network, which is probably why most emergency room co-payments are so high to begin with.  But if you end up being admitted to an out-of-network hospital after your emergency room visit, you might want to seek a transfer to an in-network provider because you are no longer protected by the emergency care stipulation.

A Kaiser Family Foundation study found that more than half of people who purchase their own health insurance plan are willing to take a smaller network of providers in exchange for lower premium costs.  They also found that there is little standardization when it comes to individual and marketplace health insurance plans.  Do your research and call your insurer with every visit if you need to, just to make sure that your health care will be covered.  If you are looking for health insurance quotes, compare health rates offers quotes from multiple insurers all over the United States.