What does being an Out-of-Network practice mean?
I'm so glad you asked. Let's go over it.
I have to admit that before I became a business owner and started my own practice, I really did not pay too much attention to all these insurance nuances. But I have learned a whole lot since. Let’s go over the terms IN and OUT-of-network.
If you have Cigna, for example, as your insurance company and I am in network with Cigna, that means I have entered a contract with Cigna. This means that I play by Cigna's rules. So I adhere to their medication policies in terms of what drugs to prescribe to patients. I have to follow the way that they want me to order certain tests, and I agree to their payment schedule if I am IN network with an insurance company.
If I am out of network with Cigna, for example, then I don't play by their rules. I create my own rules. So if I think there's a certain test or a certain medication that is appropriate for a patient, then I prescribe that. And I also have a different fee schedule compared to being in-network. So that is the very basic difference between in-network and out-of-network.
And in general, what your insurance company will reimburse you for a visit is going to be different if it's in-network or out-of-network. But there's a little bit more nuance to it.
So let me give you an example. Say you need a consult for Fibroids, and you are trying to decide between me, TheFibroidDoc, and a doctor who is in network with your insurance. You call both the places for an estimate of cost. The in-network doctor is not going to give you a cost for the consultation because, trust me, they themselves don't know. I was part of a big system and the system bills on behalf of the doctor. What they do tell you is that the insurance will cover 50% of your consultation with this in-network doctor.
But if you go to Dr. Prabakar, you're on your own. We're going to cover 0%. And you have to pay the bill. So let's look at the numbers. If you go to your in network doctor, they may charge you $1,000 and the insurance will cover 50%, which is $500. And if you come to me, my price is actually $500 for a consultation.
So at the end of the day, you have paid the same amount whether you've gone to an in network doctor or you've come to me, and the experience you get may be very, very different. So before you say NO to an Out-of-network physician, just take a look at the numbers and then make that decision.
If you are in California and you are looking for an expert gynecologist, come and see me!
I'm in Lafayette, CA and my number is 925-74-7473 , and I'll be happy to see you for a consultation.
You can set up a coaching session with me, email: thefibroiddoc@gmail.com , and we can set up a time and go over all your questions.
For more educational videos like this, visit TheFibroidDoc’s YouTube channel.
