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Dear Addy: In-Network

Dear Addy

 

Dear Addy,

I have heard from a friend that their hemophilia treatment center (HTC) is no longer “in-network” for their insurance plan but instead is “out-of-network.” What does this mean and should I be worried about my insurance plan changing?

 Signed,
 Nervous Over Network

_______________________

Dear Nervous,

The term “out-of-network” refers to those doctors, hospitals, and other health care providers with whom a patient’s insurance company has NOT contracted to provide care. Insurers contract with doctors, hospitals, or other health care providers to provide care at a set cost as part of their cost saving measures.

For example, if you use an out-of-network provider for care, your insurer may require you to pay higher co-pays, deductibles, and co-insurance for that care,  or they may not pay for any part of the out-of-network care you receive. This means that you likely will pay more to see an out-of-network provider at your HTC or have to pay for the care out of your own pocket. How much you pay to see an out-of-network provider will depend on the type of plan you have. You will need to contact your human resources department or your health insurance provider directly to learn what applies in your case.

It has become a reality that some health insurance providers do not include some HTCs in their provider network. If you are concerned about this, again, contact your human resources department or your insurer. It is open enrollment season for many insurance plans; this is the time when you have a chance to keep or change the plan you have, and open enrollment usually last 30 days. Make sure that when your open enrollment period comes up, you read health insurance plan options carefully, making sure that your HTC and your HTC doctor will be in-network for the plan you select.

For more information about open enrollment a,nd for a health insurance plan checklist to help you get the most out of the plan you choose, please see HFA’s “Are you Ready for Open Enrollment” page and check my other post about open enrollment.

Sincerely,
Addy 

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HFA frequently receives questions from the bleeding disorders community related to advocacy issues. The questions often impact the entire community. In an effort to reach the largest audience possible with our responses to these widely applicable questions, HFA developed “Dear Addy.” Questions submitted to this column are edited in order to protect privacy and should be considered educational only, not individual guidance.

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