Health plans typically contract with hospitals, doctors and other providers for discounted rates; these providers are known as “in-network”.
Health insurance providers frequently make adjustments to their networks based on reimbursement rates and administrative burden, sometimes even altering doctors who accept current plans – potentially leading to higher out-of-pocket expenses or unexpected bills for these changes.
1. Look for an In-Network Doctor
Health insurance plans often partner with networks of doctors, hospitals, clinics and healthcare professionals that they contract with to keep costs under control by paying providers at predetermined rates – thereby making care cheaper for plan members while avoiding out-of-network charges.
Doctors and other healthcare providers sometimes opt out of participating with certain insurance plans due to contract terms; contracts may stipulate higher fees for out-of-network care than for in-network treatment, leading to more substantial medical bills for patients receiving care from these out-of-network providers.
Know which healthcare providers are in-network is essential to plan members. Most insurance company websites list which healthcare providers they have contracted with; alternatively, you may wish to call each healthcare provider directly and inquire if they belong with your plan – otherwise, find another healthcare provider instead.
One of the main reasons healthcare providers drop certain plans is when they reach their capacity or workload limits, whether due to high patient demand, limited resources or just their desire for maintaining manageable patient loads.
If you have Medicare, it’s especially essential that you find a provider within its network. Most American physicians participate in Medicare and “accept assignment”, meaning they will only bill Medicare for fees covered by your plan. Conversely, if a provider opts-out or is what’s known as an “opt-in”, then all costs associated with his/her care fall on you as the patient.
If you are uncertain which healthcare providers are covered under your health insurance plan, contact them directly or dial up your health insurer’s customer service number on your ID card to find out which doctors are available in-network with your policy. Alternatively, it might be worthwhile consulting a licensed health insurance agent who can assist in finding new plans that include your current physician in its network of providers.
2. Ask for Referrals
An individual seeking specialist care typically starts by asking their primary care physician for a referral. This request may seem simple enough, and for good reason – some insurance plans require this referral in order to see specialists. Furthermore, patients visiting specialists without being referred from their primary care doctor could incur higher bills because some plans don’t cover out of network visits.
Not only can physicians help their patients to avoid expensive medical bills, they can also benefit from referrals as a source of new business for their practice. Unfortunately, it can be challenging for physicians to take full advantage of this resource given how competitive healthcare industry can be.
Un effective way to gain more physician referrals is to demonstrate your expertise. By writing articles for local publications or appearing on local news channels or blogging on your website, this will establish you as an authority figure and encourage other doctors to refer their patients directly.
Reaching out directly can also help build relationships among doctors. This could involve inviting them to networking events or even just lunch together, while sponsoring charity events or community organizations is another effective strategy to promote your practice and connect with other health professionals in your area and discuss what they do.
Physicians can foster referrals by asking their current patients to refer their practice. This simple request doesn’t need to be pushy and could yield many new patients for the practice. Some physicians may even offer rewards such as gift cards or free visits for doing this.
3. Check with Your Insurance Company
Each insurance company maintains a list of doctors and hospitals who have contracted with them; this network allows insurance companies to pay less for medical services. Before scheduling an appointment with any physician or hospital within your network, always check first with your insurance company or your online marketplace account; its contact details can usually be found either on the back of their card or within that account.
An array of factors could prompt a physician to opt out of certain insurance plans, from contract negotiations and reimbursement rates, to capacity and network updates. As insurance companies regularly revise their networks with updates of healthcare providers in their network based on contractual negotiations or reimbursement rates; this may force your physician out-of-network resulting in higher out-of-pocket costs for you and them.
Make sure that your doctor remains accepting of your insurance by maintaining regular contact and asking about their policy frequently. Also ask their office if there are providers that accept it; or attempt negotiating for reduced prices or flexible financing solutions from them.
If your doctor still won’t accept your insurance plan, your last resort may be to reach out to your insurer directly. Most insurers provide consumer assistance programs designed to assist individuals when facing insurance problems; you can find one by searching online or calling customer service directly.
Your insurance card is an indispensable piece of paper containing key details about your health coverage. It should include information such as your name, date of birth, and insurance company name. Keep this safe in a secure place and show it to each new doctor you visit; their staff should make a copy for themselves and verify its accuracy before giving out copies to patients.
Selecting a doctor that accepts your insurance plan is key to receiving high-quality medical care, and by following these tips you can increase the odds of finding one who continues to accept your policy even after they change insurance plans or retire.
4. Negotiate
As costs continue to escalate, more physicians are becoming frustrated with inadequate reimbursements from insurance companies. Some have taken drastic measures, like refusing certain plans altogether and breaking off relationships; others attempt to work the system by negotiating directly with insurers – here are some tips for successfully negotiating.
Start by researching what your physician can charge without insurance coverage, using websites like Healthcare Bluebook as a resource to compare prices for services you are seeking. This will give you an idea of what to expect when calling your physician’s billing department and establish any discrepancies – such as incorrect medical codes or missing records – before calling them directly.
Once you know the amount your doctor can charge, contact your insurance provider and request a rate increase. Prove to them that the doctor is overcharging by comparing his charges with those of similar providers in your area; this puts them in an advantageous position when negotiating.
If your attempts at persuading insurance to raise their rates have proven unsuccessful, patient advocates are available as another resource to assist you. They have extensive experience dealing with health insurers and can negotiate your bill directly on your behalf before filing claims so that any payments due will reach you quickly and efficiently.
If you are having difficulty finding a doctor who accepts your insurance plan, it may be time for a change of providers. While it may be disappointing to part ways with one you like dearly, having one that does not accept your policy would likely be better than nothing at all. Furthermore, even if your physician doesn’t take it directly you could negotiate discounted fees or ask for referrals of practitioners that do. Lastly if financial assistance programs through local hospitals might help; such assistance programs could offer relief when fees cannot be afforded directly.