When Saraswati needed to visit an urgent care clinic for a sinus infection, she called before she left to make sure they accepted her insurance. The receptionist confirmed they would take her insurance plan, and Saraswati was prescribed antibiotics for her infection.
She was shocked to receive a bill for out-of-network services a few months later.
“Why am I getting an out-of-network bill?” she asked. “They said they took my insurance.”
“Accepting” or “taking” insurance is confusing verbiage that can lead to surprise bills. When a facility or provider says they “take” your insurance, that often means that they will file the claim for you.
It can also be tricky to ask directly if they are in-network. Bigger insurance companies sometimes buy smaller insurance companies, or smaller companies may be affiliated with bigger companies. The provider may contract with ABC Insurance Company, but your plan may actually be ABC Silver Blue. This sounds like it should be the same, and it might be. But it also might not be. Contract issues may also lead to changes in this information. A provider who was contracted a week ago may not be when you make an appointment. Or the person you call may be simply mistaken.
So how can you really know if you are seeing an in-network provider? Best thing to do is check the insurance website. This information is usually located under a menu option that says something such as “Find Care.” You can then filter results by specialty. In Saraswati’s case, she could have filtered by urgent care to find the specialty she needed at the time.
Always double-check to make sure the provider you are seeing is in-network. Taking five minutes to check can save you hundreds or thousands of dollars in out-of-network costs.