Make Sure Your Health Insurance Bills Stay Low by Using Providers in Your Network

Ok. You've signed up for health insurance through Covered California or directly through an insurance company. You did your due diligence, shopped around, perhaps even spoke to an insurance adviser, like me. And you found an insurance program that you like. It fits your budget and covers your anticipated health-related needs. You even made sure that you will be able to continue to see the doctors and visit the hospitals that you are familiar and comfortable with. So far, so good.

But you still have to be alert and inquisitive when obtaining health services. Virtually all health insurance policies restrict coverage to certain doctors, hospitals, labs and other services that are "in network." For covered services that are "in network" under your policy, you may be responsible for a co-pay and the services may be subject to your policy's deductible, but the bulk of the cost will be covered by your insurer. However, if you receive services from providers outside of your policy's network, you may be responsible for the full cost of the service or procedure. (Sometimes insurers will cover, or partially cover, out of network services if approved by the insurer in advance).

This can be a budget buster. Here is an unfortunate, but all too typical story: The patient visits his Primary Care doctor for a standard annual checkup. His health is fine and he anticipates a few questions from the doctor and some blood work. His policy covers this care and he pays a $3 copay. But a few weeks later he receives a bill from the blood lab for $800 dollars. Why? Because the doctor sent the blood work to a lab that was "out of network" for his policy. The patient, who is normally a cautious consumer of health services, could have checked with the doctor to make sure that the blood work was sent to an "in network" lab.

The lesson? Be a careful and informed consumer of medical services. Wherever possible confirm in advance that proposed services (not only lab work, but visits to specialists, tests, procedures of all sorts) are "in network." This may require persistence on your part. Doctors (and their staff) don't always have that information at their finger tips, and they are busy people. But you need to know if you want to avoid unpleasant and costly surprises.

The health care system works best for all of us when consumers are fully informed.

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