I made an appointment with a chiropractor the other day to try and help the back pain I’ve been living with for several months. This chiropractor came highly recommended by a close friend, but when I checked with my health plan, I couldn’t find him listed there. So that left me with a decision to make: Go to this chiropractor for treatment and take on potentially high out-of-network costs, or cross my fingers, choose a chiropractor from my plan, and hope for the best. It’s a tough decision, and one many of us have had to make at one point or another when it comes to in-network versus out-of-network care.
We’re all interested in avoiding unnecessary costs, so if you are considering going out of network, follow these tips to help keep your out-of-pocket costs to a minimum:
- Get cost estimates from the hospital and the physicians, and try to find out if there are any incidental fees you can avoid.
- Research what portion your insurance will cover. Know that most plans will only cover a percentage of charges they consider "reasonable and customary." This may be a lot less than what the hospital and doctors charge; you'll be responsible for the difference. And find out if your insurance company will pay the entire "reasonable and customary" portion, or if you'll be responsible for some of it due to deductibles or co-insurance.
- Ask doctors if they are willing to accept your insurance company's payment for their services as payment in full, especially if they work in a hospital that's covered by your plan.
- Don't be afraid to negotiate with your insurer in advance. They may be willing to pay for a procedure at an out-of-network hospital, or performed by an out-of-network specialist, if there aren't any in-network options. Your physician should help you justify the necessity.
In the end, I went with an in-network doctor (also recommended by a friend) who helped relieve my back pain, without hurting my wallet.
—Ginger Skinner
Read more on how to prevent unnecessary hospital costs.
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