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“Is this doctor in my network?” Maybe.

It seems like the answer to this question should be a simple yes or no. It is undoubtedly one of the most frequently asked questions by individuals when reviewing their health insurance options. In truth, however, the answer is often more complicated.

Many participants take great pains to research which doctors and hospitals are considered in network providers, most often when facing a surgery or other complex procedure. Yet they still end up with huge bills. How can this happen?

Let’s say that a physician has multiple offices. Not all of the offices may be part of the network. Should a participant choose the wrong office, the procedure can be considered out-of-network. The same can be said for a doctor that is part of more than one practice.  Although the doctor may be in network in one practice, the same is not necessarily true for the same services provided in a different practice.

Even doctors within a group practice may not be part of the same network. So if a particular medical group practice is listed as in network, some physicians may have agreed to accept rates negotiated with an insurer, while others have not. Those physicians would be deemed out-of-network. When investigating physicians, network participation isn’t always transparent and requires a careful look.

A critical component of a hospital network are physician and service providers at that hospital. An in network hospital may rely on out-of-network physicians such as emergency room doctors, radiologists and anesthesiologists. Individuals cannot assume that because a hospital is in network, all of its providers are included in the same network. Sadly, many individuals don’t discover this until they receive an explanation of benefits outlining hospital costs.

Before you select a physician, dig deep. Be sure that you research every aspect of your care, especially if this includes a hospital stay. There can be less in your network than meets the untrained eye.

For additional information, contact EAB HealthWorks.