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Out-of-Network Providers in In-Network Hospitals

Within an episode of medical care, one of the first (and most important steps) is the selection of your provider and/or facility. Making these selections within your health plan’s provider networks is essential: by choosing in-network care, you save.

Unfortunately for consumers, this can get a little muddled when receiving care at hospital. While a hospital may be in-network, the providers may or may not be. Yes, you read that right: just because a hospital is in network, doesn’t mean all the providers practicing there are too.

Out of Network Providers in an In-Network Hospital

Why?

A hospital’s participation in a health plan does not necessitate the same from all the providers working in the hospital. These doctors negotiate their own contracts and networks. So while they might work in a hospital, they might not belong to the same network.

What It Means For You

Consumers save by staying within their network. Depending on the type of coverage and details of their health plan, receiving care from an out-of-network provider could result in footing a larger portion of the bill or the entire bill.

Avoid Paying More

To avoid paying more, stay in-network. While that can be tricky, especially in a hospital environment, remember to:

Know the details of upcoming care.
Know who will be providing care during a scheduled procedure. Many procedures require more than a single provider. For example, during a surgery a patient might be treated by an anesthesiologist, surgeon, assisting surgeons, radiologist, pathologist, etc. Knowing exactly what type of providers will be participating in medical care will guard against any surprise out-of-network care and help anticipate and understand medical bills.

Check that each provider is in-network.
Now, confirm with the health plan that each of provider is actually in network. If there are out-of-network providers scheduled, reach back out to the coordinating doctor and request in-network providers instead.

During a Medical Emergency

While taking action upfront helps eliminate pricey out-of-network care for planned hospital procedures, consumers can’t always anticipate when they’ll require medical attention. At any moment, any one of us can become a patient. In emergency situations, consumers can’t (and shouldn’t) focus on making sure the providers are in-network.

Send Us Your Questions

Struggling to manage significant hospital charges? Surprised to find your recent medical care was out-of-network even though the hospital was in-network? Comment below.

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