Beware of In-Network Doctors with Out-of-Network Facilities
July 31, 2009 – 1:52 pm by DrEric
As 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% ...