Chelsey Tucker graduated with a Bachelor of History degree from Metropolitan State University in 2019. She now writes about insurance with her specialty being life insurance and has been quoted on Help Smart Phone and MEL Magazine.

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Dan Walker graduated with a BS in Administrative Management in 2005 and has been working in his family’s insurance agency, FCI Agency, for 15 years. He is licensed as an agent to write property and casualty insurance, including home, auto, umbrella, and dwelling fire insurance. He’s also been featured on sites like Reviews.com.

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Reviewed by Daniel Walker
Licensed Auto Insurance Agent

UPDATED: Mar 19, 2020

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Out of network doctor explains health insurance costs.

If you went to an out of network doctor and didn’t know they were out of network, you have a few options.

You can confirm that the doctor really is out of network, you can ask the doctor to join your network, and you can plead for discounted billing. If none of these devices work for you, then you will be subjected to pay all deductibles, co-pays, and out of network costs for which you are billed.

To obtain insurance rates on policies your doctor already is a part of just use the free quote tool now!

Whether you are prone to illness or not, having health insurance is a valuable asset. Depending on your medical history, health insurance can save you up to tens of thousands of dollars every year.

However, most health insurance plans work with a network of doctors which is why you are able to save money on your health insurance and subsequent medical bills. If you go out of network, all of that changes. Out of network costs can skyrocket, leaving you paying for your bills as if you had no health insurance at all.

Out of Network Doctors

If you have ever gone to the doctor without insurance, then you know the prices can be quite steep. Having the exact same office visit with health insurance can save you a lot of money. That is because the doctors who work with your insurance provider agree to provide you services at a discounted rate. The doctors do this because, in exchange for accepting lower rates, they are given additional patients (other people who are using your insurance and choosing that doctor from the network).

It gets tricky if you go to a doctor who is out of your network. A doctor who is not in the network has not agreed to accept reduced insurance rates and does not receive any patient referrals from the insurance company. If you choose to go to a doctor that is out of network then you will have to pay whatever that doctor charges you. Some health insurance offers financial relief for out of network doctors, but it is usually a small relief that doesn’t make going out of network financially worthwhile.

If you went to a doctor that was out of network because you didn’t know he was out of network, then you may be quite shocked when the medical bill arrives at your house. Before going to any doctor, you should always make sure that he works with your health insurance provider. It is a good idea to even routinely check with your regular practitioner just in case he stops working with your insurance provider.

Before you go into coronary shock over your unexpected out of network medical bill, call the doctor and confirm that he truly is out of network and that this isn’t just a billing error. (It probably isn’t, but it doesn’t hurt to check.) Then call your insurance provider and do the same. If the doctor is out of network you can ask him if he is willing to join the network or if not, if he is willing to at least reduce your fees.

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Out of Network Doctors Joining your Network

“You won’t know if you don’t try” is a good expression for asking your doctor to join your health insurance network. Most doctors already work with a handful of networks and are reluctant to work with yet another one. However, if a doctor receives multiple requests from different patients for the same network, he may be inclined to change his mind since it would ultimately mean more business for him.

If your doctor agrees to join your network, then ask him if he will extend the discounted rate to your previous bills. If your doctor does not join your network, then ask him to discount your rate anyway. Again, “you don’t know if you don’t try.”

Requesting a Rate Reduction from Out of Network Doctors

Going to an out or network doctor unknowingly can be quite a painful surprise. However, you may be able to get a reduced rate from the doctor just by asking for one. If you ask him to join your network and he declines to do so, ask him if he will at least honor the discounted rates. He is not obligated to reduce his fees for you since it is your responsibility to confirm a doctor’s participation in a network. However, he may be empathetic and willing to discount your bill.

If the out of network doctor does not offer you some financial relief on the billing statement, ask about the possibility of setting up some type of payment plan. Installment payments can reduce the burden of a large bill by giving you more time to pay the money owed.

Always find out if a doctor is in your network before scheduling your appointment. Networks are powerful and help offer lower health insurance rates to patients like you. If you went to an out of network doctor and didn’t know it then you can ask the doctor to join the network. If he chooses not to join the network, ask him if he will honor the network rates for you or least give you a discount. Once you have a health insurance plan you can easily find out which providers are in the network.

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