What if I Need Out of Network Health Care?

Posted in

February 2nd, 2009

Even with a full network of medical providers offered in your health insurance plans, there may be times when going out of network for health care is essential. Generally, out of network health care is more costly than using the doctors in your HMO or PPO plan, but if it is a matter of life or death, you might not have a choice in the matter.

If at all possible, consulting with your in-network primary doctor first will greatly improve the chances of your health insurance provider covering out of network costs associated with your treatment. If your primary doctor knows that you have a rare ailment and cannot locate an in-network specialist to treat you, they can help you get the treatment you need elsewhere. They can also help you negotiate with the insurance system if they know that changing providers could affect your health.

Even if you have to go out of network unexpectedly, your health insurance company may cover some of the expenses as long as certain requirements are met. If you have a medical emergency and must seek the closest available help, this is usually covered by many plans. This can also apply to receiving care while out of town or during a natural disaster. To help get the financial coverage you require, you (or someone on your behalf) will typically need to contact your primary-care physician or your insurance company within 48 hours of treatment.

The most important thing to remember if you need out of network medical assistance is to notify your insurance provider quickly and explain your situation. Make sure your family has the phone number of your insurance company so they can call on your behalf if you are unable to yourself.