Hard times of our lives can happen when we are insured but the company will not reimburse due to out-of-network bills. Such situations usually don’t happen on normal days of treatments or check-ups. They happen only in emergency situations. So let us see in the upcoming paragraphs how to tackle such situations.
On dealing with emergencies
If the patient has undergone a serious head injury in a road accident, the emergency physician will start to treat his patient in a note to save his life. At that critical time, doctor cannot ask the patient about his insurance network or undercover policies. Simply he does his duty to save patient’s life. All the medical bills can be claimed from the insurance provider when the triangle is perfect. The triangle goes in such a way that all the three must be connected with a same bond.
X is the insurance provider; X must have good access with Doctor and with the patient. This is called in-network and patient can claim medical bills within the X provider without any confusions.
Y is the insurance provider; Y has got access with Doctor and the patient has got access with X. This is called Out-Of-Network. The triangle gets confused here. In this case the patient finds harder to claim reimbursement from Y for getting treatment with physician of provider X.
All insurance providers will have a policy to provide reimbursements only within in-networks. On such cases like Out-Of-Networks the patient has to pay money from their own savings or go for a loan.
The problem arises for both the P’s- Physician and Patient. Since both were not aware that they belonged to different insurance service providers, the revenue cycle for physician gets disturbed and the patient starts to struggle for paying his medical bills with any reimbursements. For tackling this situation the patient must be aware of insurance providers on Out-Of-Networks only on emergency departments and clarify with all these issues before signing a contract with them.
The patient can even file appeals on huge medical bills which cannot be afforded. Such cases will be considered and court will recommend the Y insurance provider to reimburse the patient’s medical bills.
Before getting into any of the insurance providers, both the P’s must be pretty sure on emergency departments and their revenues in such cases. The provider which people choose must help them on their needed times and save them from debts. These are some of the precaution steps which can be taken to save from huge losses for both physician and patient.
Nowadays emergency physicians are provided with good revenues by insurance providers for such Out-Of-Networks services. The insurance provider must be considerable is the only fact. So be aware before choosing a policy with insurance provider in all costs. Try to negotiate such issues before signing the insurance policy as it can give a clear cut idea about your insurance provider on hard times of your life.
Always stay with the best insurance provider who explains these emergency departments without any hesitations.