In-Networks on your ACA (affordable care act) policy are very important to keep in mind when you are looking at other U.S. insurance options. Why? Because in and out of networks have become more important starting with the ACA laws. When you purchase an ACA plan you are “leasing / renting” strong or weak medical networks.
Good Neighbor Insurance provides both group and individual health care coverage in Arizona, as well as travel insurance for those vacationing overseas and for expats residing overseas. We are happy to be able to share the following information for our clients who currently have individual coverage.
Thanks to the first essential health benefit as defined by the Affordable Care Act, “Emergency Services” (Trips to the emergency room) are covered both in and out of network.
This is care you receive for conditions that could lead to serious disability or death if not immediately treated, such as accidents or sudden illness. Typically, this is a trip to the emergency room, and includes transport by ambulance. By law you cannot be penalized for going out-of-network or for not having prior authorization.
But what about NON-Emergency services?
What our clients need to know about these types of services:
1. Carry your membership card everywhere.
2. Make copies. It’ll save huge amounts of hassle if you have an unexpected doctor or hospital visit.
3. Understand your plan’s doctor and hospital network.
4. Insurance companies negotiate participation and payment rates with a network of providers to control costs.
5. Many of the on exchange plans, in order to stay affordable, have much smaller networks than people are used to. It’s important to remember that just because your friend has a plan with the same insurer and can go to a particular hospital, doesn’t mean that you necessarily can too.
6. You can check a plan’s directory — either online or often part of the documents you receive when you enroll — to find out if specific physicians and hospitals are part of your network. You can call doctors’ offices to confirm, too.
7. Stay in the network!
The health law says that, once you join a qualified plan, you won’t pay more out of pocket per year than $6,350 for an individual and $12,700 for a family.
But this applies only to in-network care. Whether you’re in an HMO that pays almost no out-of-network benefits or a PPO that covers some, the pocketbook protections don’t apply if you use a non-network doc or hospital. Non-network providers also frequently bill you far more than what they charge patients in their networks for the same procedure.
Be sure to save all of your paperwork. This will allow you to make sure you really owe what doctors and hospitals bill you for.
If you have any concerns, it really is worth it to make a call to the and get them to explain what they did.