Medically reviewed by: Dr. Robert Segal, M.D.
You’ve recently started a new job – new pay, new perks, and most likely, a new health insurance plan. Fast forward a few months later, you go in for your annual check-up with the doctor you’ve had for years, only to hear: “Sorry, we don’t take your new health insurance.” Faced with paying out-of-network costs, you leave your doctor’s office confused and upset. What was wrong with your new health insurance plan? Why did your doctor’s office accept your old plan and not the one you have now? Well, I’m here to break it all down for you. Each year, doctors, labs, hospitals – essentially almost all businesses in the healthcare profession – work with health insurance companies to come up with a price insurers like you will pay for health needs. The providers set down their list price for how much their services should cost, of which insurance companies will most likely counter, and thus begins the back-and-forth negotiations between your healthcare provider and your insurance company. And since it’s basically the insurance company that has the final say in what you pay and what your healthcare provider gets paid, it is entirely possible for a deal to not get made. So, how does this all affect you? With any plan, you’re paying less because your health insurance company has negotiated a lower price with your in-network providers, which is good for you. But in this particular scenario I’ve laid out, chances are this also means you’re getting a much smaller group of healthcare providers at your disposal. After all, if your preferred provider is unable to accept the price set forth by your health insurance company, they simply won’t accept your plan as reimbursement for their services. But there may still be good news for you. As I said, each year the prices are negotiated between health insurance companies and providers. So you may find that one year your preferred doctor isn’t taking your plan, but the next year they are. Your best bet to avoid hearing those dreadful words that your health insurance isn’t accepted is to be informed and prepared. But if you’re waiting anxiously for your out-of-network bill, know that you can ask your doctor and health insurance company to renegotiate to see if you can lower what you have to pay out-of-pocket. In short, take the time and effort to investigate all your options. Trust me, it’ll all be worth it and your health and your wallet will thank you.
LabFinder is a no-cost, online platform for people to easily schedule their medical tests and view results securely. The LabFinder team is passionate about improving the ‘patient and doctor experience’ through better communication, reduce out-of-pocket expenses and making everyone know more about their own medical tests. The mission of LabFinder is simple: we want to be solution to you and get you the test results you deserve so you can make right choices about your health.
Written by: LabFinder Team / Approved by: Dr. Robert Segal, M.D.