Answer
What should I check before an appointment or procedure?
The short answer
Before planned care, check three things: that the provider and facility are in your network, whether you need a referral or prior authorization, and what it may cost. Ask your plan and the provider. Write down who you spoke with and when.
Key takeaways
- The doctor and the hospital or surgery center can have different network status.
- One procedure can create several bills, such as for the facility, surgeon, anesthesia, and lab.
- Federal rules protect you from many surprise out-of-network bills, but not every situation.
Words in this lesson
- In-network
- Providers and facilities that have a contract with your plan for agreed prices. Usually costs you less.
- Out-of-network
- Providers and facilities without a contract with your plan. Care often costs more or may not be covered.
- Referral
- A written order from your primary care doctor to see a specialist. Some plans require it.
- Good faith estimate
- A written estimate of expected charges that you can ask for if you are uninsured or not using insurance.
- Surprise billing
- An unexpected bill from an out-of-network provider you did not choose. Federal law protects against many of these.
- Facility fee
- A charge from a hospital or clinic for the use of its space, staff, and equipment, separate from the clinician's fee.
Related
This is general education. For decisions about your own plan, taxes, or legal rights, check your plan documents or a qualified professional.