Question regarding Network insurance...?

Question

A policy I'm looking says this (refering to the difference between Network, PPO, etc....)

"Network. A network of physicians, hospitals, and other health care providers that have agreed to provide medical services to a health insurance plan's members at discounted costs. While the health plan's members are free to use any health care provider, the cost to use network providers is less than using non-network providers."

Now, does that mean if I use their network Dr's, say I accumulate 5,000 worth of medical and my deductable is the first 10,000.... So say I use 5000, then I go to an out of network Dr and say I spend 2,000. Will that 2,000 be counted towards my 10k yearly deductable or no?

Answer 1

One of the most important things to consider is when using a network provider, your incurred charges could be reduced considerably due to the contract between the provider and your insurance carrier. For example: (and I am just making up numbers for example purposes)

$15,000 total charge - $5000 (PPO network discount) = $10,000. You have saved yourself money upfront by using providers in the network.

As others have stated you may have two separate deductibles. One for in-network and one for out-of-network. When you read your plan benefits, it may have 4 sets of numbers:

It may look like this:

       In Network                         Out of Network

$10,0000 / $20,000                $20,000 / $40,000

The represents the $10,000 for your deductible, and the $20,000 deductible if you have dependents.  The $20,000 / $40,000 Out of network.

Some carriers will let the out of network deductible satisfy in network deductible, but you would need to call your carrier to find out.

Good luck!

Answer 2

Jenny is not exactly correct.  You could have different deductibles first of all for in and out of network.  The other part of the equation is if you go out of network and they bill you $2,000 and the insurance company only approves $1200 you'll end up spending $2,000 but only $1200 will count towards your deductible.

So, the answer is that you might have separate deductibles but only a percentage of out of network expenses will count toward the deductible.

For all intents and purposes Network and PPO are synonymous.  But, go with the first response as you should be working with a broker to answer your questions.

http://www.InsurancePickle.com

Answer 3

You should ask your agent this question. There is no extra charge using an agent and it's much easier and quicker talking with an agent than trying to do this yourself.

It depends on the policy, but most policies will have a separate deductible and a different co-insurance for out of network services. Also, check to see if the doctor visits are subject to the deductible; with most individual plans they aren't in network but they may be out of network.

Answer 4

When you have a deductible...regardless if you go to an in network dr. or out of network dr., you are paying out of pocket and that will apply towards your deductible.  If you go to a doctor is out of the network, you will be paying more out of pocket, because technically your insurance doesn't have to pay at all if they are not in network, but still will be applied to deductible.