You were so careful during open enrollment. You checked your doctors, prescriptions and everything else you and your family needed. Yet, seemingly out of nowhere, an out-of-network charge appears. How can that happen?

Networks are narrow and getting narrower. If you or a family member see a primary care physician in the office which you have verified is in-network, you will have seen an in-network physician. But if any ancillary services are required during the visit, then the outcome of those services may be different. For example, say your physician’s office draws blood during the visit. Which lab does the practice use? Do they use more than one lab? The lab may be out-of-network. Should this be the case, you may want to have the physician write a prescription for blood work to be done at an in-network lab.

For the most part, colonoscopies are considered a preventative service, and are covered by health insurance. If you’ve selected an in-network provider, then you should be fine, right? You’ve verified that the facility where the procedure will take place is in-network and your doctor has indicated that this is a preventative screening. But what about the anethesiologist? Depending upon the facility, this doctor may not be in-network, and that is often the case with non-resident hospital facilities.

 

The bottom line is that regardless of what you believe to be in-network, follow up must be done on an ongoing basis. Physician networks change regularly, and those physicians in multiple practices may not be in-network in all of the practices. It is also not unusual for a doctor to use an out-of-network lab for blood work. Assume nothing. Whether it be a procedure or a routine office visit, ask before anything is done to avoid surprises.

For additional information, contact EAB HealthWorks.