Wednesday, December 12, 2018

Big Scary Health Insurance Pitfall

Friend-of-the-Slog Paul Trapani points out a little-known health insurance pitfall contradicting my assurance in yesterday's posting that a plan's maximum out-of-pocket "is the point where your insurer shuts up and pays. Forget coinsurance, copays, deductibles, etc.; the health care system opens up and saves your ass from potentially infinite expense."

First, one note: not one of the Affordable Care Act plans in NY state include any provision for out-of-network treatment.
There’s a potential gotcha with “out of network”. I don’t think the maximum out-of-pocket applies there. You can obviously choose in-network when it comes to your personal physician and specialists, etc., but you may find yourself at an in-network hospital, being operated on by an in-network doctor and they call in an out-of-network anesthesiologist or other out-of-network-specialist. People have been hit with high bills because of it.

This can be extremely expensive, because out-of-network doctors never agreed to your insurance company's negotiated rates and can charge whatever they want.

In the event this happens to you, you have two plays:

1. Apparently insurance companies sometimes relent and pay.

2. You can negotiate a payment plan with the out-of-network provider, even if it’s a minimal figure like $20/month. They are willing to work with you out of fear that you'll declare bankruptcy, leaving them completely unpaid. Not ideal of course, but it’s something....

But wait! Read this!

No comments:

Blog Archive