What costs are associated with the surgery that would impact out of network vs. in network? I'm leaning towards HEI but since they're not in network wondering what that really means in dollars.
Pam ~
Virtually all of the costs of your AN surgery will be included in the 'out-of-network' insurance coverage provisions of your policy if you opt for HEI. Because every insurance company has a slightly different rate structure you should look at your medical insurance contract information or call the insurer and ask them. Sometimes the contract language will be ambiguous and use the term
'reasonable and customary' to set the amounts they'll pay. However, most medical institutions have contracts with insurance companies and agree to accept what the company pays, although, in most cases, whatever the insurer
doesn't pay (
usually stated in the contract as a percentage) you'll probably be liable for... unless the doctor and/or institution agrees beforehand to waive the remaining costs beyond what your insurance agrees to pay them (
don't count on that happening). That's what's on some of the many forms you'll be asked to sign when you check into the hospital (
any hospital...they all do this to protect themselves) so know exactly what you're signing and get the payment arrangements clear, especially if you'll owe the hospital. Most medical institutions support some sort of payment plan although they usually want you to agree to pay your bill in full within 12 months, but those agreements are situational, specific to the institution and the patient's negotiating skills. However, most hospitals are reasonable.
I suggest that you make some phone calls (
HEI, your medical insurer) and know where you stand, financially, before opting for or against HEI, the institution you stated you would prefer to use.
Jim
