In-Network vs. Out-of-Network Doctor

In Network vs Out of Network.jpg

On Friday, Kasey woke up with a scratchy throat. Life is too busy to give in to a cold, so she took a ginger shot from her favorite juice place and went on with her day. Saturday rolls around and she woke up with a scratchy throat and a nose so full of gunk she could barely breathe. While a bubble bath with Lush’s latest bath bomb sounded more appealing, she headed to the closest Urgent Care because she needed to kick this ASAP.

Fast forward three weeks and Kasey’s cold is long forgotten, but there is suddenly a bill in her mailbox for $195 from...her urgent care visit?!? It only lasted 10 minutes!

Kasey gives them a call only to hear Anna at the billing office say “It looks like we are out of network with your insurance provider, so they didn’t pay much for the office visit and lab test. We can give you a 5% discount if you pay in full today!”

“Awesome, a $9 discount on my $195 bill...”

Let’s rewind.

What if…instead of strolling into the nearest Urgent Care, Healthcare Hustler Kasey fired up her laptop and logged in to her insurance provider search. She looked for the closest “in-network” Urgent Care, called them to verify, then went to her visit. Her claim processed as expected, and she got a more reasonable bill thanks to the pre negotiated “in-network discount”.

Why you want to go in-network:

  1. Your insurance has already negotiated cheaper prices with these providers, and these providers cannot bill you above that price.

  2. Any amount you do owe may apply to your in-network deductible and out of pocket maximum. This means you are reducing your potential out of pocket costs for the year’s future expenses.

  3. The provider is required to submit your insurance claim on your behalf. You don’t have to do any extra work.

  4. If you have a copay or coinsurance, you will pay a lower price than you would at the out of network option.

Want to know more? Learn how to find in-network providers and more about the urgent care vs. the emergency room.