5 essential facts about health insurance

Out-of-network benefits can be costly
Out-of-network benefits can be costly © Monkey Business Images/

The typical health insurance plan includes a network of doctors, health care facilities and other providers that either work for or contract with the insurance company and agree to provide services at a particular rate.

In most cases, insured consumers may still use out-of-network providers, but they need to understand that there's a difference between in-network and out-of-network benefits, says Keith Tobin, vice president of Medorizon, a medical billing company based in Romeoville, Ill.

When you go out-of-network, you could be stuck paying a higher coinsurance percentage. And often there are higher annual coinsurance and overall out-of-pocket limits when using out-of-network providers. Depending on your plan, you could even be billed for 100 percent of the costs when you seek out-of-network care.

But it may be necessary to use out-of-network providers if, for instance, a health care crisis occurs while traveling. In some cases, a provider may be in your network but the hospital where that provider works may be outside the network, presenting questions about whether the services provided there will be covered, Tobin says.


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