Hello Bedford Residents
For all of you that have a health plan whether you’re currently working or retired and on Medicare. In our health plan program there’s a distinction of in-network versus out-of-network.
Here’s the distinction between the two:
– In-network providers are contracted with your health insurance to accept discounted, pre-negotiated rates.
– Out-of-Network providers have no such deal, meaning you pay a much higher out-of-pocket cost and you risk facing balance billing.
1. In-Network (The Preferred Choice)
How it works: Your insurer and the doctor, hospital or dentist have agreed on a set discounted price for every service.
Your Cost: Lower, you only pay your plan’s standard copay, coinsurance, or deductible.
The Protection: Because the provider is in-network, they are legally bound to accept the negotiated rate as payment in full. “They cannot balance bill.”
2. Out-of-Network (the Costlier Choice)
How it works: The provider does not have a contract with your insurance plan. They can charge whatever price they want.
Your Cost, Much Higher: Your insurer will only pay their standard “allowable amount” (which is much lower than the doctor’s bill) your responsible for the remainder.
Many strict plan’s (like HMO’s) will not cover out-of-pocket services at all, leaving you with the entire bill.
3. The Emergency Exception Rule:
True medical emergencies are an exception: Federal law generally requires that insurers process out-of-network emergency room visits as if they are in-network.
When in doubt, check if a specific doctor or dentist is covered by your plan by calling member services on the back of your insurance card.
This is a topic I wanted to share with everyone because it’s important to all of us.
Peace to all
