A PPO plan might say that it will pay 60 to 80 percent of out-of-network care. That does not mean it will pay 60 to 80 percent of the actual bill, though. It means it will pay 60 to 80 percent of what the insurance company thinks the test or treatment ought to cost. Consumer Reports found lots of examples of patients being hit with astronomical bills. Bottom line, stay in your network. If you must go out of network, research ahead of time what your insurance company will pay.
Also research what the test or procedure should cost. Two services Healthcarebluebook.com and Fairhealthconsumer.org?let you search the cost of medical services by ZIP code. Sometimes you can use that information to negotiate with the non-network provider you want to use.
If you get a big bill, don't just complain to the insurance company. Enlist your employer and your state insurance department to help resolve the matter.
Consumer Reports says that you can end up paying more than necessary if you pay the first bill you get. The charges may be the higher "list" prices. Wait until you get your explanation of benefit or EOB to see what you really owe. Consumer Reports has more health care costs and ways to save.
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