3 Times You May Be Out of Network — and How to Avoid This Costly Mistake

3 Times You May Be Out of Network — and How to Avoid This Costly Mistake

1000 667 Bethany Ockerbloom

Have you ever gotten a medical bill that didn’t look at all like you expected? You’re not the only one. The usual culprit? Surprise out-of-network costs. Staying in network, especially when using a plan like an HMO that doesn’t cover costs out of network, is paramount to saving on health care expenses.

If you’d prefer to avoid the shock of opening an unexpected bill in the future, look out for the following three times you might be out of network without realizing it.

1. Traveling Out of State

When you’re traveling, the least of your concerns is likely how you’re going to visit a doctor while you’re gone. Unfortunately, when a medical concern does come up, a common problem is that in-network doctors are hard to find. Unless they identify a nationwide network, many plans only cover doctors within the region those plans are based in.

Emergency care will always be covered regardless of network, but if you’re dealing with most other medical issues, be sure to look for the right doctor. For real peace of mind, you might want to look into supplemental accident coverage for anything that requires immediate medical care while you’re away.

2. Out-of-Network Referrals

It’s not necessarily your doctor’s job to ensure that any other practice they refer you to is in your network. This can often be rectified by examining your carrier’s list of providers to check that any visits to new doctors are covered.

Of course, occasionally there’s no one else you can go to, and your only option is an out-of-network doctor — usually in cases of rare diseases or areas with limited medical resources. You may be able to submit a formal request to your carrier to be able to see those providers at in-network prices. The first step is working with your physician to submit your request.

3. Out-of-Network Providers at In-Network Hospitals

Even if the hospital you visit is in network, you still may not be protected from out-of-network costs. Every doctor within a hospital operates under their own network, so for any given procedure, you might receive care from a surgeon, radiologist, anesthesiologist or pathologist whose network is different from the hospital’s — and potentially not covered by your insurance. Even the labs in a hospital could operate under a separate network from the rest of the hospital!

Speaking with your doctor about your network and insurance needs is the best way to receive all levels of care while enjoying in-network prices. If it’s too late for that, you may be able to negotiate pricing with the hospital. This is not a guarantee, however, so having an open dialogue with your doctor is the best way to avoid crazy costs.

As surprising as they may be, all of these instances of health care costs are fairly common, and it’s important to do your research to find the best solution. Knowing is half the battle, and with this knowledge, you have a better shot at staying healthy within your budget.

Bethany Ockerbloom

Bethany Ockerbloom specializes in health insurance policy, Affordable Care Act news and reform, employee benefits, and other healthcare-related topics such as lifestyle and wellness.

All stories by:Bethany Ockerbloom

Bethany Ockerbloom

Bethany Ockerbloom specializes in health insurance policy, Affordable Care Act news and reform, employee benefits, and other healthcare-related topics such as lifestyle and wellness.

All stories by:Bethany Ockerbloom