Whether you’re traveling for pleasure or for business, sometimes accidents and illnesses happen while you’re away from home. How does receiving care outside the region in which you reside affect the amount you’ll have to pay?
To understand what this means for you, you’ll first need to understand the term “network.”
Usually, your health insurer’s network contains physicians who practice in relatively close proximity to you. More specifically, your insurer’s network consists of health care providers who have agreed to accept the plan’s proposed amount for the services they provide.
Let’s say a doctor in your city charges $190 for a routine office visit. If your provider’s approved amount is $100, the doctor will agree to accept this reduced rate in exchange for the increased volume that comes with being part of the network.
If a provider isn’t in a health insurer’s network, no such agreements exist between them. So, if you’re traveling outside of your network, and the provider who serves your needs charges a higher amount for services than your insurer’s approved amount, you will, more than likely, need to pay the difference between those two amounts.
There are exceptions, of course—which is why we mentioned that the answer to the original question depends upon your specific situation. Some health plans contract with other networks for members who reside, travel or attend school outside of their usual service area. Other exceptions may include emergency medical services, approved referrals to out-of-network specialists and transplant services.
To find out if your health plan has an agreement with other networks, you may wish to take a look at your insurance identification card. If you see other networks listed on it, you can seek medical care from a provider that is participating with the additional network and still pay in-network rates. The very best way to be sure about your network—its reach and its limitations—is to closely read your policy. A little knowledge and preparation can go a long way toward ensuring a health issue doesn’t cause a catastrophic financial event for you.
Here’s one last thing to remember: Even if you seek medical care close to home, make sure the provider who is treating you is in your network. If he or she isn’t, you’ll be subject to your plan’s out-of-network rates.
If you are looking for individual or group health insurance, contact us at (888) 535-4831 to get in touch with an agent who can help you through the process, or request a quote at https://www.sanfordhealthplan.org/get-a-quote.
Current Sanford Health Plan members can access their SBC and other plan information in their secure member portals at sanfordhealthplan.com/memberlogin or by contacting customer service at the number listed on the back of your insurance member ID card.