In-Network Provider With Health Insurance – Be Diligent

In the past few weeks I have had couple claims issue arise regarding “Network Services.” These have been with health insurance carriers and how they contract with their providers health insurance carrier.

In these cases it was a laboratory and an urgent care center. With the laboratory, a member had blood drawn and tests to be completed with a stand alone laboratory. This lab was an in-network provider with their health insurance carrier. but the lab sent the blood to be completed in a laboratory out-of-network provider with their health insurance carrier.

 

And in the other case, a member went to an urgent care center that was an in-network provider with their health insurance carrier. but the physician who treated the patient had not signed his contract yet and was therefore considered an out-of-network provider with their health insurance carrier. In both cases the out-of-network benefits were not good at all. But we were able to help both of these members get these corrected and had the claims paid as in-network provider with their health insurance carrier. But that may not be the case with similar situations.

Bottom line is this. You as the health care insurance member must be very diligent where you are receiving any type of treatment. Please ask everyone you come in contact with and confirm they are an in-network provider with your health insurance carrier. And especially under the new Affordable Care Act contracts, this is extremely important.