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Health plans have a specific group of doctors, pharmacies, hospitals, and other healthcare providers you can use at a contracted price. This is your network.
Since you pay for part of the costs of your medical care, it's important to know that you will almost always pay less when you see an in-network provider. Services from out-of-network providers may cost more, or may not be covered at all by your plan.
One danger of using an out-of-network provider is balance bills. "Allowed amounts," are set rates your in-network providers can charge for services and procedures. An out-of-network provider is not obligated to charge you the allowed amount.
So, if you have a procedure with an in-network provider who usually charges $200, but the allowed amount is $150, they can only charge $150. The doctor writes off the other $50.
If you have the same procedure with an out-of-office provider, the provider can balance bill you the $50. Your LifeWise plan will only cover the allowed amount (less copay and deductible).
It’s important to know when visiting an out-of-network provider that you can be charged out-of-pocket expenses (costs not covered by your health plan), including your deductible and copay. Out-of-pocket expenses for out-of-network providers often do
not apply to the annual out-of-pocket maximum. Your out-of-pocket maximum refers to the most you could pay during a coverage period for your share of the costs of covered services before your plan pays 100 percent of eligible expenses.
Out-of-network expenses could
include: lab work, durable medical equipment (wheel chairs, orthotics, and braces), cpap (breathing machines), referrals to specialists, radiology (x-rays, CT scans, and MRIs), and physical therapy.
Confirm with your provider that the services you are receiving are in-network to avoid higher out-of-pocket costs.