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Compare Health Insurance Limitations: Out-of-Network Providers

aldwin sab October 3rd, 2011 0 comments

Limitations can make or break a private health insurance policy – or any type of insurance plan.  They can significantly undermine the value and effectiveness of your policy. Here are some vital points to consider about your network.

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“Your” Doctors

You love your doctors, right?  Indeed this can be quite a positive – or negative – aspect of your policy.

This is the starting point of the limitation that we’ll get into later.  At its most basic, you should be aware of whether your doctors are covered, especially when you compare private health insurance to find a new policy.  Don’t forget about specialist doctors and doctors for your children – they can be important in unforeseen circumstances.

Also, extend this approach to less common areas of medicine.  If your policy covers chiropractic practitioners, you’ll need to make sure that he or she is “in the network.”

Know Your Network

The network for a health insurance plan will control how you obtain treatment.  Obviously, you’ll want it to be as flexible as possible. Sure, you’ll want to see if your doctors are on the magical list.  But what about nearby hospitals?  How about doctors and treatment centers near your top vacation spots – or close to your extended family?

These types of questions will allow you to enter into a deeper understanding of a policy.  Network limitations can be the main difference between two similarly-priced policies.  As you might imagine, it can be a huge letdown to be reduced to limited options when you or your family need care.

When you compare private health insurance, take an in-depth look at each insurance company’s network before you purchase a policy.  You might even need to take a look at your existing policy – your network may be less impressive than you hoped.

Out-of-Network Providers

Let’s be clear: the objective is to get a health insurance policy with a strong network of practitioners, so that you’ll have widespread access to a variety of healthcare services.  However, now we can discuss what happens when that is not the case.  This is a limitation that you should be familiar with, to know what you’re getting into (at times, it can be unavoidable).

If you go to a treatment centre or doctor that is not in your network, there are several things that can happen – and they’re not generally good.

It may be that your out-of-network treatment is covered, but not at the normal rate; you will pay more in this case.  However, it can get worse: you may not be covered at all.  Hence, we see the importance of preventing these situations and of knowing your policy – you won’t want to drive 15 more minutes to save money when someone needs urgent medical care.

It might not be that bad, though.  This can be the case when your doctor refers you to an out-of-network specialist.  In that case, you could be fully covered just as you would in-network.  This distinction is important to be aware of, obviously.

The moral of the story?  Compare health insurance with care, and know your (potential) policy or policies.  It can save you a lot of money in unexpected situations.

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