What is Out-of-Network Benefits?

Insurance is confusing. I don’t think I really understood insurance plans until I started my own practice and was forced to learn it for the families I was treating; Here’s my form of Insurance 101:

Every plan is different. 

The most proactive thing you can do before going to your doctors, is call your insurance company and inquire about your benefits. Caring and thoughtful practitioners will be able to help you as well, but even practitioners like me will call your insurance company to get the details about your plan. In bigger group practices, they might divide the responsibility among other staff members (aside from the practitioner you are seeing), which can get a little tricky. So inquiring and learning about your plan is important if you don’t like surprise bills. 

Out-of-Network VS In-Network providers

Typically you can scan through your In-network providers on the insurance company site. These are the practitioners that became part of the insurance community to assist those in need. The co-pay might be listed on the card, and you pay at your visit. Out-of-Network is another part of the plan that has its own list of benefits. Some insurances do not provide Out-of-Network benefits; so this is something you have to check with your insurance company. With Out-of-Network benefits, you might have a deductibles or a different co-pay, but it may help with some specialty (and small businesses like myself) services to assist you better. 

If you have any questions about your benefits or how In vs Out-of-Network benefits work, please contact us and schedule a consultation; we’re happy to help.