No. of Recommendations: 2
The real problem with going somewhere out of network is that you don't have protection against balance billing.

Let's say you go to an in network provider who would charge $1000 for a procedure. Your insurer might have a contract to pay $200 for it. The contract also typically provides that the in network provider must accept that $200 for the whole thing and can't charge you for the balance (the $800). So - from your standpoint as a patient - it's all good. This even works if you are still in your deductible. Let's say you had a $500 deductible. All the in net work provider could get from you would be the $200 that the insurer would have paid if you weren't still in your deductible.

Now, let's say you go to an out of network provider who would charge $1000 for a procedure. Your insurer has no contract with that provider. However, your insurer will only pay what it considers a reasonable amount. That would typically be something like the $200 it would pay to an in network provider. So your insurer (assuming you have met your deductible) sends $200 to the out of network provider. But, the out of network provider (having no contract with your insurer) will then balance bill you for $800. You might be able to negotiate something lower or might not.

So - if it was me - I would not be going to the out of network clinic that your PCP referred you to. Find out who would be in network for the specialty in question and have your PCP refer you to someone in network.
Print the post  


UGC Disclosure Notice Regarding Credit Card Posts
Community board discussions about credit cards are not provided or commissioned by banks who may have advertising relationships with The Motley Fool. Responses have not been reviewed, approved or otherwise endorsed by the bank advertiser. It is not the bank advertiser's responsibility to ensure all posts and/or questions are answered.
TMF Credit Center
The Motley Fool Credit Center arms you with real tools and simple messages, that will help you in every credit situation.
When Life Gives You Lemons
We all have had hardships and made poor decisions. The important thing is how we respond and grow. Read the story of a Fool who started from nothing, and looks to gain everything.
Contact Us
Contact Customer Service and other Fool departments here.
Work for Fools?
Winner of the Washingtonian great places to work, and Glassdoor #1 Company to Work For 2015! Have access to all of TMF's online and email products for FREE, and be paid for your contributions to TMF! Click the link and start your Fool career.