What You Need To Know about Looking Up Benefits and In-network Care
The intricacies of healthcare benefits and in-network versus out-of-network care can be confusing and intimidating. Here’s what you need to know about looking up benefits and in-network care.
1. Look up Billing Procedures
When you start a new healthcare plan, you should check its billing procedures and processes. See if there is a paperless option or if you need to pay by mail. Check whether you can pay through your insurance provider’s website or you need to pay your healthcare provider directly. You can also check your deductible, in-network and out-of-network expenses and whether your bill is accurate.
Additionally, you should check about procedures for dealing with so-called surprise bills. Surprise bills are unexpected or higher-than-expected bills. They are often related to out-of-network or emergency care. While uncommon, there are ways to prepare for and deal with these surprise bills. If you are planning to have major medical care, make sure it’s in-network or talk to your insurance provider if you must go out-of-network. You should also prepare for the possibility of requiring emergency medical care out of state. While some insurance providers span the United States, many only cover certain regions or areas. Check your plan’s policies and the costs of emergency care before going on trips so you can make informed decisions in case of a medical emergency.
2. Learn about Your Plan before Looking for Providers
You should always look up your insurance provider’s policies before going to a healthcare provider for non-emergency treatment. For example, if your regular doctor refers you to a rheumatologist, you should check online and/or call your insurance provider to ask if there are any specifics regarding insurance coverage when you see a specialist. Generally, the specialist will be covered by your insurance, but co-pays and other costs may vary significantly from routine providers like general practitioners.
3. Learn the Difference between In-Network and Out-of-network
In-network refers to participating providers – healthcare providers who take your insurance plan. The main difference between the two is that an in-network provider will be more cost-effective than an out-of-network provider. In-network healthcare providers accept the rates dictated by your insurance provider, but out-of-network providers are under no such obligations.
4. Check What Services are In-network
Sometimes, your insurance plan will be able to help cover the cost of certain out-of-network procedures or healthcare providers. All insurance plans will pay for any emergency medical care you receive, whether the healthcare provider is in-network or not. In non-emergency situations, some healthcare plans will cover some of the cost of an out-of-network provider, while others won’t pay anything at all. Even the ones that do help cover the cost of out-of-network care will typically cover much less of it than they would for in-network care.
5. Learn How to Find In-network Providers
Many insurance plans will offer a search function that allows you to find in-network providers in your area. However, you should always call a provider before you see him or her for the first time to ensure that the information from your plan’s website is correct and the provider does take your insurance.
6. Know Your Connection is Protected
There are many ways to protect and secure internet protections. If you’re looking up specifics related to your plan and your health, then you’re likely logged in to your insurance provider or healthcare provider’s network, which is a secure connection. However, there are ways to protect connections even when you’re just browsing. These include HTTPS, data encryption and SSL. HTTPS and data encryption are rather well-known, but you might be thinking what is SSL? SSL stands for Secure Socket Layer. It is a method of encrypting and decrypting internet connections to secure them against third parties attempting to access or change data.
Every healthcare plan is different and every beneficiary has different medical needs. However, every benefits package will include the aforementioned topics in some capacity. If you know the basics of what to look for, you should be able to find these topics in your plan.
