ivinsfan
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
- Joined
- Feb 19, 2007
- Messages
- 9,962
All plans must provide emergency care coverage, even if the provider is out of network. The policy holder is still subject to balance billing, which means the policy holder is still liable for excess charges not covered by the plan. In addition, the ER service must meet the insurer's requirements for coverage.
Any care that is "non-emergency" must be in-network and meet all other eligibility criteria. For health insurance, it is critical to understand the insurer's network of providers.
So in "insurance talk" this means for an emergency you can go out of network, but your carrier will only pay the "usual and customary" price they use for your HMO..so you might have a bill of 100K and your insurance might pay 10...there is no "knockdown price" for out of network and you are possibly on the hook for 90K...to the poster that RV'd and wanted to save 5K, this might be your future. Am I understanding this correctly?