The purpose of Health Insurance is to decrease the cost of medical services. A medical facility will bill your insurance company to receive reimbursement for services they provide, which decreases the cost you have to pay. They do this by submitting a claim to your insurance company using your plan number or ID .
There are two categories of insurances:
In-Network (IN) and Out-of-Network (OON).
IN means there is a pre-arranged term of reimbursement and contracted rate for medical services prior to visitation. The benefit of this category is it tends to provide cheaper medical services. However, facilities have to abide by insurance company policies, which sometimes is not what the patient needs, potentially limiting crucial medical services.
OON services allow a provider to bill the insurance company but are not contracted to be part of the network. The benefit of this category allows a facility to provide greater medical services in less crowded facilities. Individuals who choose OON services are free to select their medical provider with no constraints from the insurance company.
In Network:
Your providers are chosen for you from the insurance network
May not provide the medical services you need
Overcrowded facilities
Beholden to insurance companies
Tends to be cheaper
Out of Network:
Get to choose your provider
Select the medical services you want
One on one care
Tends to be more expensive
What is best for You
Whether you choose to go with a clinic that is IN or OON, check with your policy prior to your visit. Many individuals have high deductibles which means it could cost the same no matter where you go. You might as well choose the option that is going to get you the best bang for you buck. You don't HAVE to use your insurance, no one can force you where to go.
If you'd like help understanding your policy, our team of experts is here to help. We will be able to explain your benefits in a way that you can understand and give you the option to make the best medical decision for your health.
Click here to schedule a call with the AVION Team