Health insurance is one of the essential expenditures one incurs in their life. For professionals, health insurance could be taken care of by the employer. Having health insurance is not a guarantee that one gets compensation after filing a claim. Various factors determine whether an insurance claim will be approved or not. These include the affiliation of the medical facility and its staff to one’s insurance agency. One of the main concerns is when one gets services from an out of network anesthesiologist. Anesthesiologists play an essential part in operation rooms; they regulate the amount of anesthesia one receives during the operation. However, most health insurance policies do not cover the cost of anesthesiologists. This results in surprise billing of patients when the anesthesiologist is considered out of the network by the insurance cover. Patients receive a bill for the services offered by the anesthesiologist, which they have to settle beside insurance coverage.
Disadvantages of Out of Network Anesthesiologists
To cut down on costs of funding medical expenses, insurance agencies create a network of anesthesiologists. In most cases, the networks have very few anesthesiologists that many hospitals contract out of network ones to help in operations. As a result, the insurance agency does not cover the costs of anesthesiologists. Here are some disadvantages of out of network anesthesiologists.
- High medical care expenses- The essence of health insurance is to minimize the financial burden one might incur when accessing medical care. Out of network anesthesiologists provide a loophole for exploiting unsuspecting patients. This makes medical care unaffordable for many middle and low-income earners. Although patients have the freedom to choose whether they should be handled by an out of network professional, they cannot choose in case of an emergency. Financial constraints arising from unexpected anesthesia bills affect patients’ recovery and rehabilitation.
- Minimal accountability- Out of network anesthesiologists are not easily held responsible in case of a mistake while at work. Health insurance should take care of any other injury or complication that might arise as a result of a treatment procedure. Some agencies might decline insurance claims if the mistake is committed by an out of network anesthesiologist. As a result, it may take long before one receives justice. It may be assumed that one is not legally insured against damage resulting from out of network anesthesiologists as most of them are usually outsourced to help with operations.
- Limited choice for patients- In cases where one understands the impact of using out of network anesthesiologists, they might not have other options. As stated earlier, the networks created by insurance agencies have few anesthesiologists making it hard to find an available one easily. The lack of choice in case of an emergency has an adverse impact on one’s mental health.
There are several other disadvantages of out of network anesthesiologists. Although general pricing of services is standardized by the government, some medical facilities might overcharge since very few patients can petition the unexpected bills. The cost of legal representation in most cases scares patients away, making them suffer in silence.
How to Avoid Out of Network Anesthesiologist Bills?
Despite the disadvantages, there are several ways of avoiding surprise bills as a result of out of network anesthesiologists. These include;
- Understanding your insurance cover- The first step to avoiding unnecessary expenses is understanding all the benefits of your insurance cover. When signing up for a policy, you should take time to investigate all that is covered. Some policies cover both in-network and out-of-network anesthesiologists. In cases where one is not covered, you should be mentally and financially prepared to take care of additional charges.
- Inquire from the medical facility- Before being treated, you should ask about the standing of the medical facility. Whether there are in-network options available and how much it would cost if an out of network anesthesiologist is brought on board. If the case is not an emergency, one should be accompanied by a legal representative to explain critical points that they might not understand. Physicians tend to terminate contracts with insurance agencies after some time. When being handled by your preferred physician, consult to ensure they are still listed as an in-network option.
- Ask for recommendations- One of the easiest ways to find an in-network anesthesiologist is by asking for recommendations. However, the recommendations should be from people on the same insurance policy as yours. Agencies have different networks; this implies that an in-network anesthesiologist under one agency could be out of network in another. There are various ways to ask for recommendations. Thanks to technological advancements, you can get recommendations from online platforms such as social media and websites.
- Inquire about gap insurance policies- Gap insurance policies are most common in automotive insurance. However, they are also available in health insurance. These are supplemental insurance policies that cover critical illness, accidental death, and injuries arising as a result of a medical procedure. Having these policies helps in case a mistake is committed by an out of network anesthesiologist and could take time before the claim is accepted.
- Ask the facility for financial assistance- Various medical facilities have programs that help patients offset their medical bills. In the absence of gap insurance policies, you can have your bill settled from charity programs at the medical facility. For those who fall under the financial hardship category, it is easy to convince the medical facility for a favorable payment plan. The facilities might forgive a portion of the debt in some cases.
There are many other loopholes in health insurance that could lead to financial constraints. Therefore, one should be careful when subscribing to a health insurance policy. Before signing up, you should go through all the benefits you can receive in case of sickness. Having a list of in-network physicians helps prevent unexpected expenses when seeking medical care. Lists of in-network physicians could be found on agencies’ websites. One should check the lists regularly since some physicians tend to terminate their contracts with insurance agencies.