Many people will find themselves in the position of dealing with a non-contracted provider.
What will this mean in regards to your insurance coverage? Depending on your plan, you may find that you now have little to no coverage for these procedures.
For example, many PPO plans will state that they cover 50% on non-network procedures.
However, it is important to realize that this means that they cover 50% of the allowable amount, rather than 50% of the overall procedure. Example:
Say you see a non-network provider and receive $1000.00 worth of care. The insurance company’s allowable amount for this procedure is $400.00.
Therefore, the insurance company pays 50%, leaving you with $200.00 PLUS the excess charges of $600.00. You will end up paying $800.00 for your non-network provider’s services.
If you had utilized an in-network provider, you would not be charged for the excess fees.
Therefore, we strongly recommend you utilize in-network doctors, medical facilities, and hospitals.
Make sure you research your doctors prior to having any sort of medical procedures performed, and don’t hesitate to ask any questions.
We are always here to help you understand your benefits, so please call us today!
Tags: health insurance, network provider, ppo
