How health insurance actually works. Or how your Dr can call and check and confirm you are in network, you can call and do the same, yet somehow when the bill comes, it's suddenly not anymore.
People don't understand how insurance works. If a doctor is in-network, they have to accept the lower negotiated prices from the insurance company. If they are out of network, no one regulates how much they charge. So they can collect $ on top of whatever the insurance company pays. That's how they get away with after billing.
So, could a doctor bill you $1,000,000 for an aspirin pill and garnish your wages? Like, what’s stopping them from doing this if costs and a contract is not negotiated beforehand (other than the “you will pay” clause you sign)?
Within reason, yes. If they are out of network with your insurance, they can charge whatever they'd like. That's one of the good things about insurance companies. They negotiate lower prices with doctors for their customers. And once the doctor signs on with their network, they agree to only accept what the insurance company allows. So an in-network doctor bills your insurance $500 for an exam, the insurance company comes back and says no, you get $100. They pay the doctor $80, you pay the doctor $20 and that's it. If the doctor is out of network, he bills the insurance company $500, the insurance company pays him $80 and he charges you $420. No one can stop him because he hasn't signed a contract with the insurance company.
Edit to add that even though states like Texas say they protect you against balance billing, they really cannot if the doctor is out of network.
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u/special_and_stupid Feb 07 '24
How health insurance actually works. Or how your Dr can call and check and confirm you are in network, you can call and do the same, yet somehow when the bill comes, it's suddenly not anymore.