People often pay a $15 or $20 co-pay for services billed by participating providers, but may incur substantial out-of-pocket expenses for non-participating providers or out-of-network services.
Some health insurers have lowered reimbursement levels for non-participating providers by changing from the usual and customary fee method to a calculation based on the Medicare fee schedule.
Although providers may accept the Medicare fee schedule for Medicare beneficiaries, they can bill non-Medicare patients for significant amounts in excess of the fee schedule allowance.
As an informed consumer, how do you find out how much a procedure may cost before you incur expenses?
FAIR Health Inc. is an independent not-for-profit organization that collects data from insurance companies nationwide. At www.fairhealthconsumer.org, you can estimate charges for medical and dental procedures by geographic area. You can estimate out-of-pocket costs by using the various methodologies and compare this to the method your insurer uses. Consumers can also access a glossary and other health insurance resources.
If you have questions about how your health insurance plan reimburses out-of-network costs, please contact the customer service department of your health insurance company. The telephone number is usually on your identification card.