If you are insured, selecting a health care provider that is not in your network can cost you more out of pocket.  Network providers in your health plan have discounted rates for their services.  Non-network providers do not provide this discount and you’ll end up paying more for their services.  Sometimes the specialist, or provider that came so highly recommended with the highest quality ratings, is not in your network.  How should you approach this to make the most of your health care dollars?  Here are things to consider when deciding to use in-network versus out-of-network providers.

Quality is very important.  You want to find the highest quality provider that offers the best value.

Get cost estimates from the hospital and the physicians, and try to find out if there are any supplemental 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, and you'll be responsible for the difference.  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 providers 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.   Make sure you take care of this before services are provided.

Negotiate with the provider and even offer to pay cash at time of service for special discounts.  Know what payment amount Medicare allows for this service. If you need help finding out this information, send me an email and I will walk you through the steps on how to find this information.  Know what payment amount your health plan allows for an in-network provider for this same service.  Information can be powerful.