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F.A.Q. Categories > In-Network and Out-of-Network

What if the provider I want to see is out-of-network?
If you want to see an out-of-network provider, be aware that only a small portion of your services might be covered by your insurance plan, or they may not be covered at all. Check with your insurance company regarding their coverage on out-of-network providers. Next, be up-front with the provider. Let them know that they are not in your insurance network. Ask them if they would be willing to give you the "in-network" discount. If they are, be sure to get this agreement in writing before you receive care and/or services.
What if I used an in-network hospital, but the hospital used an out-of-network lab or anesthesiologist?
If you were not told ahead of time and did not sign a document informing you that you were receiving services from an out-of-network provider, the out-of-network provider usually is required to provide services at the in-network negotiated rate. Contact your insurance company and make them aware of the situation. Enlist their help in sorting out what an in-network price should have been. They will have leverage with the providers that you may not.
If I see an in-network provider, will all of my services be covered?
Remember, just because a provider is in-network, it does NOT mean all the healthcare services and treatments you receive will be covered by your insurance plan. Using an in-network provider simply means you get the services at the negotiated rate. What your insurance ultimately will cover is outlined in your policy and varies between insurance companies and plans.
How do I know if a provider is in-network?
Your insurer typically provides access to a directory of doctors who are in-network. However, as that list can change quickly for a number of reasons, the only way to be certain is to check with the physician’s office. It is best to specifically ask them if they are part of your insurance network.
Why did my insurance not pay much of the out-of-network bill?
Insurance plans typically cover a smaller percentage of out-of-network bills. Since there is no discount typically given, the patient portion of the bill is often higher than with a comparable in-network physician.
I received treatment from a provider who is out-of-network, without getting pre-authorization or telling me that he is not in-network of my insurance. Am I responsible for the medical bills?
Unfortunately if you are covered under a traditional HMO, you likely do not have any coverage outside of your network. Other insurance networks, such as PPOs or POS plans have varying policies for coverage of out-of-network providers and services. They may or may not cover a percentage of the bill. Remember, as the patient you are responsible for obtaining pre-authorization and verification that the provider is in-network under the specifics of your health plan. Always check before receiving care and/or services.
Why would I be asked to sign a promissory note?
Your healthcare provider would ask you to sign a promissory note if you are agreeing to receive care that is not covered by your insurer.