You can avoid unexpected medical bills by knowing how your plan works. Certain choices you make can affect what you’ll pay out-of-pocket. Know the difference between in-network and out-of-network care to help save on health care expenses.
To help you save money, most health plans provide access to a network of doctors, facilities and pharmacies. These doctors and facilities must meet certain credentialing requirements and agree to accept a discounted rate for covered services under the health plan in order to be part of the network. These health care providers are considered in-network.
If a doctor or facility has no contract with your health plan, they’re considered out-of-network and can charge you full price. It’s usually much higher than the in-network discounted rate.
Why does out-of-network care cost more?
- You’re probably paying full price. When health insurers don’t have a contracted relationship with out-of-network doctors and facilities, they can’t control what is charged for services. And rates may be higher than the discounted in-network rate.
- You may have to pay the difference. If your doctor’s bill is higher than what your plan will pay, you might have to pay the difference. Many health plans list an amount that is the most they’ll pay for a certain service received out-of-network. If the doctor or facility charges more than your plan is willing to pay, you could be responsible for paying the difference in addition to your deductible, copay and/or coinsurance. In-network doctors and facilities have agreed not to charge you more than the agreed-upon cost.
- Your share of costs is different – and usually higher. A copay is the amount you pay for covered health services at the time you receive care. There are no copays when you use a doctor or facility that is out-of-network. But you are responsible for paying the coinsurance, or a percentage of covered charges. This may be much higher than the in-network copay or coinsurance amount.
Cosmo Insurance Agency is a full-service independent insurance agency based in Hackensack (Bergen County) and Lakewood (Ocean County), New Jersey that offers an all-encompassing range of insurance options for both individuals and businesses. Cosmo keeps its promise to assure an efficient and creative approach to the services we offer. Each of our clients experience a personalized and long-term relationship with us. Our New Jersey based team of health brokers guides our clients in helping them choose the most cost-effective options. By incorporating our knowledge of the insurance guidelines for healthcare, employee benefits, life insurance, self-insurance, dental, disability, and long term care insurance, we keep our clients up-to-date with affordable plans that cover all their specific insurance needs.