Thursday, December 6, 2012

In-Network vs. Out-of-Network Care

Fair Health Consumer published an article on "In-Network vs. Out-of-Network Care".  The article discussed the differences between in-network and out-of-network care.:

Out-of-network costs by plan:
  • HMO (Health Maintenance Organization or Exclusive Provider Network (EPO)
    • The article stated you generally have to pay the full cost of any out-of-network care, except for emergencies.
  • Preferred Provider Organization (PPO) or Point of Service (POS) Plan
    • Higher deductible
    • Higher percentage co-insurance, which is a percentage of the “allowed amount”
    • The full difference between the allowed amount and your provider’s actual rate, which could be much higher
The article also has examples of In-Network and Out-of-Network Costs

Reasons for going out-of-network could be because of the following:
  • You're referred to a specialist and they are out-of-network
  • Providers who are at a hospital that is in-network, but the actual provider may be out-of-network
To view the full article, please click the following link: In-Network vs. Out-of-Network Care

To view addition medical billing and coding resources, please click the following link: Medical Reimbursement, Inc. resources page.

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