Using the services of clinics, hospitals and physicians that are within your network will save you money at most times. It is necessary to take advantage of the synergy and relationship that exist between care providers within your network. The care providers that belong to the same in-network usually have a sort of arrangement to provide services at lower fee for members within that same network. The costs of out-of-network services are always higher though this varies from network to network.
For instance, out-of-network provider cost is solely the responsibility of EPO or HMO members but POS and PPO still offer to cover some of the cost of care. PPO and POS give a discounted cost but it leaves its members with owing a higher amount despite having insurance cover.
For example, a man went for an appointment with an in-of-network dentist when he started experiencing took ache. His charge was $200 and because he is entitled to some discount with his dentist, he got $50 as discount from the $200 he is meant to pay. His insurance cover $130 from the total sum and he is left with a balance of $20 to pay.
If the man had used the service of an out-of-service dentist, he would have missed out of the discounted service and in spite of his $130 insurance cover, he will be expected to pay the balance of $70. It is up to the man to choose whether to go to an in-of-network dentist and get the discount or do otherwise and be prepared to pay extra. It all depends on individual preference.
It is obvious that staying within your network saves you cost in many ways as regards you overall health care cost. Determining if a provider is within your network is solely your responsibility to find out and this you do by asking the necessary question when you are not sure. You can verify if a provider is in-network by placing a call through to your insurance company. This will save you from making such mistake of a wrong assumption.
Balance billing occurs when you engage the service of an out-of-network provider and you are billed for the remaining balance that your discount would have covered if you had used the service of an in-network provider. The out-of-service provider will charge you for a full price of what your insurance does not cover.
In an event of getting billed for more than what you think is appropriate, it is necessary to take the following steps.
First, cross-check the calculation done that arrived at the bill you are presented with. The error could be from you and it could be from the billing department of your service provider. You can call the attention of your service provider if you found out the error is from their end.
In general, saving on the cost of your health insurance bores down to the choice of the network, plan and service provider you chose. A Health insurance pro can help you out.