A typical health plan design might have an In Network deductible of $1500; then, the Plan pays 80%. Out of Network (OON), the deductible would be $3,000, after that covering 70% of Usual & Customary Charges (UCR).
This comes to mind in the wake of a much publicized article this week about a local provider; one who is NOT under contract by most insurers, thus Out of Network. And his Office Visit charges are way more than UCR.
Worse yet, he advertises that his services are “covered” by most insurance plans.
While technically true, his gullible patients find themselves on the hook for hundreds, if not thousands, of dollars of OON charges.
Consumer advocates, amongst the best a local company called PatientCare, help individual maximize the value of their health plans.
The cost of education is a fraction of the savings.