Frequently Asked Questions

How can I go out of network for a doctor?

This depends on what type of plan you currently have. Within a health maintenance organization (HMO), you are not allowed to visit a doctor outside of the HMO network. An HMO requires you to visit only those doctors who are contracted to provide services. This, in turn, allows the HMO to keep its costs down considerably. However, if you're a member of a preferred provider organization (PPO), you have greater flexibility. With a slightly higher premium than a typical HMO, a PPO allows you to go out-of-network at your discretion and does not require a referral from a primary-care physician. If you do go outside the PPO network, you'll likely pay the cost of your treatment in full, and then submit the bill for reimbursement to the insurance company. Typically, a PPO reimburses 80 percent of out-of-network costs. Point-of-service (POS) plans will allow you to receive services out-of-network, though you'll have to submit a claim, and the percentage of reimbursement will vary from plan to plan. Indemnity plans offer the greatest flexibility, but also involve more paperwork. Because you're not in a network, you are able to see any doctor and are not required to have a primary care physician. Before your plan kicks in, though, you'll have to pay your own medical bills until the annual deductible is met. You may be required to pay upfront for health services before submitting a claim.

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