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!