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A
common reason
insurance companies sometimes
will not pay claims
is because medical care was received "out-of-network."
A network is a group of health care providers and facilities that
have contracted with the insurance company to provide services at a
fixed rate. By contracting for a fixed rate ahead of time, insurance
companies can keep the cost of medical care down and thus keep
monthly premiums lower. When we apply for a PPO health plan, we are
agreeing to rates based on contracts established between the health
care providers and insurance company. That is why companies insist
you go to
providers within their network.
It is essential that you always call your insurance company to make
sure the facility or provider you are using is in their network.
Remember, too, that
sometimes your doctor's office will say your doctor is contracted
when in fact he is not. Always check with your insurance company and
your Provider
Directory, which you can find on the internet, before getting
medical help. |
