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Lynn Pangburn, DC | Article

When Should You Use Out-Of-Network Healthcare Providers?

10/25/2012
What do you do when the chiropractic physician you prefer is an out-of-network provider with your insurance plan? Dr. Lynn Pangburn, a Mesa Chiropractor at RED MOUNTAIN CHIRO-MED, explained "An out-of-network provider is one which has not contracted with your insurance company for reimbursement at a negotiated rate. Some health plans, like HMOs, do not reimburse out-of-network providers at all, which means that as the patient, you would be responsible for the full amount charged by your doctor."

There are options where using your out-of-network provider might be just as cost effective as an in-network provider.

• You'll improve your chances of paying in-network rates for any out-of-network visits if you see your primary-care doctor first, according to the Virginia Bureau of Insurance. Ask him or her to officially recommend the out-of-network provider and write a letter to your insurance company about the necessity of that care. If you are part of an HMO, make sure you get a referral.

• If you must pay out-of-network costs, ask the non-participating provider if he or she will consider discounting the services you need.