What to Do if Your Doctor or Healthcare Provider Is Not in Your Health Insurer's Network

Negotiating, using an HSA, and talking to your doctor are some of the steps you can take to lower your bill

What to Do if Your Doctor or Healthcare Provider Is Not in Your Health Insurer's Network
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November 8, 2018

Have you gone to the doctor only to find our that your health insurance company doesn't consider the provider in-network? It happens more than you would think, especially around the beginning of the year when insurance plans change. But if you find yourself facing a large bill, there are a few things you can do. Don't forget that medical bills can also have a negative effect on your credit.

verify your doctor is in-network before going

Sometimes you can't check first. But health insurance companies often provide lists of in-network doctors on their website, but unfortunately those lists can be out of date. The only way to make sure your doctor is in your health insurer's network is to directly call the physician's office and ask if they're a network provider for your insurance company, not just if they accept your insurance. Some might accept your insurance but might not bill on your behalf or might not get fully reimbursed by the insurance company, leaving you with a surprise bill. Others might simply 'accept' your insurance and just submit the claim for you, which can leave you bearing the full cost of the bill if they aren't in your network. Don't forget to verify that any specialist you get referred to is in-network the same way.

get a written estimate

Whether or not your doctor is in-network, it's a good idea to get a written estimate of the costs involved. Very often the estimate will be very close as the provider will verify your specific insurance coverage.

labs and diagnostics might not be covered

Find out whether the lab and diagnostic services your provider uses is covered before you have the procedure. If you already had the procedure performed, call your insurance company and tell them you didn't know that the lab would not be covered. Ask if they can bill the procedure as in-network. If they refuse to do so, call your doctor's office and explain the situation. Ask why they used an out-of-network provider and if they would be willing to write off the bill. Be polite, but be firm as well.

ask your doctor to become a network provider

It's a long shot, but you can always ask your doctor to apply to become part of your health insurer's network. If you've been seeing your doctor for a long time and your insurance changes, you might get somewhere and be able to keep the doctor.

talk to the practice if you receive a bill

Sometimes you get inaccurate information from the practice regarding insurance coverage. If you discuss it with the practice, you may be able to get the original price quote, if you have one, honored. They may also accept a co-pay only payment as if the insurer had been in your health insurance provider's network. You won't know unless you ask.

negotiate for a lower rate

Doctors have lower rates for insurance companies than for patients paying from their own pockets, so don't be afraid to ask for a lower rate. Many practices will accept a lower amount than originally billed.

ask about a payment plan

Most practices aren't too terribly picky about when they get their money so long as they get it. So ask about a payment plan. You may be able to pay as little as $25 per month, but be warned that you might have small additional service fees for doing a payment plan.