The next time you visit a health care provider make sure you are paying the contracted rate and you are in network. This will help you save money and ensure that you are getting the benefit from your health insurance.
#1 The Contracted Rate
The contracted rate is a critical component of the insurance industry. In my opinion it is the single most important aspect for why everyone should have coverage. The usual and customary charge by any physician, hospital, pharmacy, or lab facility is a fraction of what the charge is with health insurance versus not having coverage.
The contracted rate is the negotiated rate agreed upon between your health care provider and the insurance company. Your portion is only a fraction of what the total bill may be. This is what will save you thousands of dollars the next time you need an expensive procedure. The balance of the claim for that expensive procedure is written off.
Example #1 the cost of a covered service at the hospital is over $30,000. Mr. Smith receives a final bill totaling $1,500 and the rest of the balance is written off due to the contracted rate.
Note: A list of covered services is found in your evidence of coverage when you were approved for health insurance. Call your health insurance company for a copy if you do not have a copy at home.
Example #2 Mrs. Jones goes in for knee surgery. The claim is for $8,800. Mrs. Jones only pays $1,100 and the balance is written off due to the contracted rate.
While many will argue that the cost of health insurance is expensive, the cost of receiving the health care you need without health insurance is astronomical by comparison.
Make sure that you pay the usual and customary rate or contracted rate on all of your health procedures and health claims every time.
One way to ensure that you are paying the contracted rate is to work with a licensed insurance agent in your state. This agent will also help you with your claims as well.
And remember, always stay In Network.
#2 In and Out of Network
When you are In Network, the health care provider accepts your health insurance.
Hospitals, your doctor’s office, labs, specialists, your pharmacy, and any health care provider you visit must accept your insurance for you to receive the contracted rate.
Staying In Network ensures that you pay the contracted rate.
The very best way to ensure that your health care provider accepts your insurance is to simply ask them and confirm. Remember, you will not get the contracted rate unless you are In Network.
A second way to ensure that you are In Network is to verify with your health insurance company or your licensed insurance agent.
Your insurance company can help you by mailing another copy of your coverage benefits summary along with a directory of health care providers that will keep you In Network. Your licensed insurance agent will also have access to the information in case you cannot find your doctor in the directory that your insurance company provides you.
Now, if you go “Out of Network”, it means that the health care provider you visit may not accept your health insurance coverage that you are paying for. In this case the visit will be very costly to you.
In most instances, going Out of Network will cost you more than twice the amount had you stayed In Network.
This day and age health insurance companies do such a great job in growing their network that you can travel outside the U.S. and still visit a health care provider that is In Network.
A company like Blue Shield automatically enrolls you into a plan that will allow you to carry an insurance card outside of your state or outside of the U.S. so that you are In Network in case of an emergency.
To find out if you can stay In Network the next time you are travelling outside of your state or outside of the U.S. simply contact your health insurance company and ask.
Final Thought
Now, more than ever, it is important that you educate yourself on the topic of Health Insurance in this country.
DO NOT GET LOST IN THE POLITICS AND THE MILLION AND ONE OPINIONS HEARD DAILY ON THE NEWS!
These people are not in your living room helping you understand how best to plan for your healthcare needs this year. Make sure that you always stay In Network and that you are paying the Contracted Rate.