Going to the hospital is traumatic at the best of times, when a person is alert and cognizant of all the obligations to complete paperwork and make sure that insurance companies have been duly notified and all procedures and treatments have been approved in advance and will be performed by in-network providers.

But when providers who are out-of-network muscle into the picture — a scenario that's all too common these days, as agreements with insurers terminate, providers move from one system to another, are acquired in a consolidation or simply do not participate in whatever plan the patient is covered by — that picture changes, usually drastically.

A Huffington Post article pointed out that, since this often happens during an emergency, the patient has very little control over whether he or she is being seen by a doctor — or has tests or lab work done — by an in-network provider. Instead, said patient is often seen or treated by a progression of people who aren't in-network and probably never have been, and that means that the patient is going to get billed for the difference between what the insurance company is willing to pay and what the provider intends to bill.

Complete your profile to continue reading and get FREE access to BenefitsPRO, part of your ALM digital membership.

  • Critical BenefitsPRO information including cutting edge post-reform success strategies, access to educational webcasts and videos, resources from industry leaders, and informative Newsletters.
  • Exclusive discounts on ALM, BenefitsPRO magazine and BenefitsPRO.com events
  • Access to other award-winning ALM websites including ThinkAdvisor.com and Law.com

© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.