Health Insurance: Out Of Network

"Out of network" is when an insurance policy offers the choice to see a doctor, get a test or treatment, or use a health care facility that is not in the insurer's network. The amount the insurer pays is generally based on a standard known as "customary and reasonable." The insurer pays a percentage of that amount instead of the billed amount. You are obligated to pay the difference between the bill and what the insurer pays.

You can minimize the amount you pay by doing the following:

• Learn about the provisions in your policy.
• Take a few minutes to think about what to do in the event of a medical emergency.
• Be proactive if you need elective health care out of network.
• If you need surgery, check on the status of all members of the team.
• If you enter a hospital, even one which is in network, watch for out of network doctors.
• Negotiate if you will have to pay more than you want.
• If you don't get what you want from your insurance company, appeal.

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