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.
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The information and advice on this website was deemed accurate when it was originally published. GNI cannot accept any responsibility or liability for any actions taken on the basis of the information provided, unless that information is subsequently confirmed in writing. For the latest up-to-date information please call us or check brochures and other published materials for latest revision/date.