Okay, so I’m going to step into dangerous territory and pull back the covers on one of the things that annoys me. I hear about this particular health insurance mistake happening A LOT more than it should: even after checking with a provider's office beforehand, you find out the provider not a member of your insurance carrier's network after all.
It’s not that doctor’s offices are lying exactly, but you may end up paying more for services by 1) not asking the right questions and 2) not understanding the answers you hear.
Let's start at the beginning
Does this sound familiar? You call your doctor, dentist, vision, or any other provider's office and ask something similar to this: Do you take ABC insurance? Their answer is a truthful “yes, we do take that insurance."
You blissfully go to your appointment and use that provider’s services. When the bill comes what you owe is not what you expected!
You make an angry call to your insurance carrier to dispute their payment only to learn that the provider you visited was not a member of the preferred network required by your insurance policy.
Unfortunately, this means that the amount your insurance company paid is what your policy pays for a non-network provider.
Because you didn’t use a network provider, you’re find yourself stuck with higher out-of-pocket costs in the form of reduced benefits, higher deductibles, higher copays, or even no coverage at all for certain services.
What just happened ?
Let’s recap. The question you asked was, “do you take ABC insurance?"
Your provider’s office truthfully answered yes. This is because when you asked, "do you take ABC insurance” you were, in their view, merely asking "will your office file an insurance claim on my behalf." However, it does not mean that the doctor you’re seeing is a member of your insurance policy’s preferred provider network. Ah-ha!
Asking the right question
You thought you did the right thing. I get it. However, you asked the wrong question. The right question to ask is:
Who will I be seeing during my visit, and do they belong to and participate in the <name the required provider network, NOT the insurance carrier’s name> required by my insurance carrier? (Not every doctor in a practice has to be a network provider, so be specific.)
You can also take the extra step of calling the provider network number on your insurance ID card to confirm that the specific doctor you’re seeing is a current network member. (If it were me, I’d make that phone call.)
Providers aren’t being dishonest. They will, however, answer the questions you ask. Knowing the right question and taking the extra step can save you hard cash and a lot of frustration.
About the Author
Judy Bezler has served businesses and individuals for over 25 years. Always telling it as she sees it, her areas of expertise include health insurance, life insurance, and disability income protection. You can reach her directly at (704) 559-9323 or simply click below.