I was trying to find out if the doctor was in-network with an insurance company.?

Question

They said - 'It is possible that the provider is contracted with the insurance company for their fully-insured book of business. That does not mean that the provider is in-network for this patient.' What does this mean?

Answer 1

The short answer is that "in-network" is a smaller group of contract doctors that charge less. You can think of them like the inhouse lawyers that corporations have, and when they get sued or have special situations, they hire outside help. The outside help charges more.

This is a very complicated question. It depends on what you have and what the plan covers. For a start, you have to begin with your specific insurance company, such as Blue Cross or Cigna or Aetna, or other. Do you have HMO, PPO, POS, Tradiditional, or other plan? And then even with each insurance company, which plan? Only that plan is able to tell you what doctors are in-network. You should call their 800 number for your specific plan and speak to an agent to get the information. You can then find the information on their web site to confirm what they say. Or you could do it the other way around, but don't trust just one source and take notes/make printout of what you find in case there's some issue later.

If you have Blue Cross, Cigna, or Aetna, try one of the links below.

Also take a look at the Health Insurance FAQ at Yahoo.

Answer 2

If the patient is not fully insured, covered for all services, then the provider may not be a covered provider for the services you are seeking. It is a standard b.s. disclaimer. Call your insurance company and find out if the services you are seeking are covered and if the provider is covered to deliver those services to you. Write down names and extensions of people you speak to, the date you called and what was said, just in case you later get a denial. Most companies will cover a service if they verbally told you it was covered and you have that information documented.

Answer 3

Call the toll-free customer service number on the back of your insurance card. Ask the insurance company who they recommend you go to (they usually keep a list). Or you could look it up online via their site. I hate that PPO thing, but you have to call ahead so you don't get wacked with those crazy bills.

Answer 4

in network means your insurance will cover it. out of network means you will foot most of the bill. Call the 800 number and find out for sure if your doctor is in the in-network..
It`s all pretty confusing.

Answer 5

Sorry, i think of you're answerable for charge for the well-being care expert pass to. The well-being care expert accomplished a provider and you're in charge for charge, if your coverage isn't paying it. docs have the suited (and frequently do) pass out and in of networks. The receptionist isn't at fault, as some docs in that workplace are in that community. coverage companies do not replace their internet site's each and every minute of each and every hour of ever day with present day information. often as quickly as/week. So only using fact the internet internet site confirmed the well-being care expert in community, it doesnt recommend that the day in the previous he didnt end. you could attempt acquiring a criminal expert and see what he says, in case you sense you at the instant are not in charge for charge. An lawyer may be greater suitable to respond to considered one of those question. sturdy success

Answer 6

It means, they don't know if he's in network or not.

Call the "members services" number on the back of your insurance card, and ask THEM if he's in-network or not.

Answer 7

if your doc is "in-network" then you are just responsible for any co-pays at the time of appointment. if your doc is "out of network" then you will be paying most or all of the bill up front and then you will need to file with your insurance company to be reimbursed for the fee that you had paid.

Answer 8

Call the free number

Answer 9

I just ask my co-workers where they go....the older co-workers seem to know where they take my insurance. Confusing isn't it....