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Avoid Sticker Shock Before Going Out of Network

Getting medical care from a provider that is not in your health insurer’s network comes with a price. And now due to a change in the way many insurance companies calculate how much they’ll pay for out-of-network medical services, the cost of that care is even higher.

Historically, says Robin Gelburd, president of the independent nonprofit, Fair Health, insurers paid a percentage of usual, customary, and reasonable (UCR) charges, which reflect the actual prices health care providers charge. However, over the past year, many insurers have instead begun using Medicare rates, which are considerably lower than UCR, to determine how much of your out-of-network medical care they’ll cover. This has come as a shock to many consumers who have been hit with bills that are significantly higher than what they expected.

Read more of my article, “Avoid Sticker Shock Before Going Out of Network” on WebMD.

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Posted in Managing Your Health Plan