Insurance 100% In network but out of network -Issue?

Question

I have PPO insurance with 100% IN network coverage and No out of network. Even though my hospital and doctor are covered ,the lab or X ray test providers (inside the hospital) are not covered or bascially comes under out of network.if i was admitted to the hospital for pregnancy i would be paying huge sum money for the out of network coverage for which i dont have the control(lab test andX ray) and already i am paying huge money to insurance since it has 100% coverage

Any suggestions how it can controlled .

Answer 1

Since you are using an in-network hospital, the lab and radiology are part of that hospital and should be paid at the in-network rate. As you stated, you cannot (and SHOULD not) have to check every single possible provider to see if they are in network. Since these departments work under the hospital's umbrella, they should also be covered as in-network. If the insurance will not pay these providers as in-network, you will need to find out who the preferred providers for these services are in your area and find out if the hospital uses these providers. In some cases, the types of labwork and X-rays the doctor orders MUST be sent to a lab that processes the types of labwork your doctor has requested. Not all do...

If you are admitted, submit a request in writing to the hospital that all labwork and x-rays must be sent to the specified providers and make sure that your doctor knows this and includes this in your chart.

In short, there is no easy answer here-and it seems ridiculous that you should have to concern yourself with this administrative redtape during treatment for a medical condition.

Answer 2

I would ask someone in the medical billing office of the hospital or clinic or birthing center how those charges are billed.  It is possible they can bill in-house-- if the hospital has its own lab and x-ray service, it usually is all included and considered 'in network' if the hospital or facility is.

Answer 3

Maternity is usually billed on a, "global," basis. There is one lump sum paid by insuror to the provider of care, with all tests and screenings leading up to the birth included in the lump sum amount.