Beware of In-Network Doctors with Out-of-Network Facilities
July 31, 2009 – 1:52 pm by DrEricAs a patient and healthcare consumer, you can get caught in a trap that can cost you a lot of money. First as background, many medical services have two bills–the doctor bill and the facility (i.e. hospital or surgery center) bill. Some doctors who perform procedures–such as gastroenterologists that perform colonoscopies and surgeons that perform operations–do so at facilities that are Out-of-Network.
So here is the trap… The doctor themselves may be In-Network so that when you see them in the office before the procedure it may be a low copay or low out-of-pocket cost, but when you actually have the procedure done, the facility bill will be VERY large and you will be responsible for MORE of the bill.
For example:
In-Network colonoscopy facility fee: $800 You may be responsible for 10% coinsurance, so you pay $80.
Out-of-Network colonoscopy facility fee: $3,000 You may be responsible for 30% coinsurance, so you pay $900.
How do you avoid this trap? Ask BOTH the doctor’s office and your insurance company if the facility where you are to have the procedure is In-Network. And, ask both the doctor’s office and your insurance company what your Out-of-Pocket costs will be.
It is certainly the doctor’s right to practice at an Out-of-Network facility, but it is also YOUR right to know that in advance.
If you don’t ask, it may be too late after the procedure and you will be out $880.
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