Paying Out of Network claims based on the Medicare Allowable Fee Structure is the new U & C

Has anyone gone to a non network doctor recently? Chances are you will be paying quite a bit more than you are used to. This is because many of the insurance carriers are reimbursing these charges based on the same allowance as Medicare perhaps adding a small percentage. This can cause quite a balance due.

What can you do? In this environment, doing a little bit of homework can go a long way. It is important to know the provisions of your plan and how out of network providers will be reimbursed. If you must use an out of network provider contact them prior to services being rendered to find out what they will charge. You can then contact your carrier to see how the charges will be reimbursed. Of course the preference is always to use the network but when you can’t you do not want to be caught off guard.

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