What Should I Do if My Doctor is Out of Network

What Should I Do if My Doctor is Out-of-Network?

One of the most common mistakes people make when enrolling in or updating a health insurance plan is assuming that their doctor or healthcare provider is part of the network. They often experience shock when they pay up to 100 percent of their medical bill because they have an out-of-network doctor.

If you encounter a situation where the healthcare provider you just used is not in your health insurance company’s network, you need to explore your options and choose the one that provides the best medical care for the lowest amount. Let’s look below at what you can do if your doctor is out-of-network. 

Option 1: Find a Healthcare Provider in Your Health Insurance Company’s Network

Perhaps the easiest option is to explore your health insurance provider’s network and find a healthcare provider. You can go online to your insurance company’s website to find a list of providers.

If you need help, your health insurance broker can also find a provider based on your needs. When choosing a provider, shop around. Don’t just choose the first name on the list. Make sure the provider is a good match, offers all the services you need, and offers competitive prices for their services.

Option 2: Request That Your Doctor Be Added to Your Network

Adding your doctor to your health insurance network is a two-part process.

First, your doctor has to agree to be in the network. While health insurance companies are always looking for the best doctors, doctors also choose which networks they want to be a part of. So, the first step is to consult your doctor.

Second, if your doctor decides to be a part of an insurance company’s network, they may apply for acceptance from their office. You don’t have to do anything. If the doctor leaves it up to you, simply contact your health insurance broker, who will know how to complete the application process.

Option 3: Ask Your Health Insurer to Cover Out-of-Network Services

You can keep your health insurance company and your out-of-network doctor simultaneously by requesting a network gap exception. When you request a network gap exception, you ask your health insurer to cover out-of-network care as though it were in-network. 

You pay for care at the lower in-network costs. Your portion of the care you pay for counts toward your in-network deductible. The drawback to this request is that most insurance companies will turn you down if you don’t provide a compelling reason for the exception. However, you may get an exception if you cannot find a provider for the type of care you need.

Option 4: Find a Health Insurance Discount Plan

Medical discount plans are much less expensive than health insurance, but they do not provide any medical protection like a health insurance policy. Instead, they simply give members a discount on medical services. If you choose to use your out-of-network doctor, a discount plan can offset the additional medical expense. 

The discounts are not guaranteed and can vary significantly depending on the provider and treatment.  There is no cap on out-of-pocket costs with a discount plan, and they are not regulated by the ACA. Each state regulates medical discount plans.

Contact Insurance Enterprise for Personal Health Insurance

If you have questions about health insurance and need quotes, contact Insurance Enterprise at 888-350-6605 Speak to a health insurance broker and find out more about how you can get an affordable health insurance plan.