I have had very little personal experience with hospitals.
Q.: If one needs hospital care (presumably this means that they are experiencing something serious health-wise), how does one figure out whether it is in-network or not?
omni
Good question. This article gives an excellent explanation, and I would suggest that anyone who isn't absolutely sure of their healthcare provider contract, spend the time to look up the details.
In-Network vs. Out-of-Network Care
I'll add a little story from 20 years ago, that happened to us. A veritable nightmare.
DW and I were vacationing in Florida, when she suffered a stroke. At the hospital, it was determined that she had a carotid artery blockage which would require immediate surgery.
At the time, we had our health plan with an HMO in the Chicago area. Prior to going in for the surgery... (best doctor in the southeast), he called our HMO doctor for permission to operate as we were then out of the approved area.
While this should have been a no brainer... emergency... our HMO doctor was conveniently unavailable for approval. I had to sign a "responsibility" document in order for the operation to proceed.
I expected that this would be just a technicality, and that the nature of the emergency would be recognized and of course the bills would be paid. Also , of course, there would be a recovery period in the hospital... again, refused, with the suggestion that she should go back to an approved facility in Illinois.
How?... The HMO suggested a medivac flight... again at my expense.. The estimated cost was $26,000. Of course I refused, and DW's recovery was in the Florida Hospital. Who cares about money at a time like this.
Still, I expected that it would all be straightened out. It was not to be... We received bills totaling more than $120,000... (and that was more than 20 years ago)
It took days of calling back and forth, letters to the governing body of the hospital, affidavits from the surgeon, appeals to the patient advocate organization and many sleepless nights... (we had just recently retired)... to finally get approval.
So... yeah. Thing like this can't happen, but they do. We were simple and trusting, and the $8000/year in HMO charges... plus the wonderful "caring" part of their advertising, had given us a feeling of security. Who would read the page three note about out of plan services, in a document that was twenty pages long?
The world is more sophisticated now... healthcare is better understood by many, and warnings about legal limits of responsibility are more in the news.
Still, surprises are common, and with a tightening of the legal rights provide more loopholes for providers to avoid paying.
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Sadly, healthcare is only one of the legal contracts we sign for services, that we don't read because of the length and the small type. The simple recap that comes as a cover letter hides the details. for instance, our Comcast agreement is a 24,000+ word legal document. In many cases, not much we can do about this, since we need the services... phone, house insurance, vehicle insurance, life insurance, and things like roofing guarantees, or service contracts....
It's the rock and a hard place. Impossible to live our lives sitting at a desk, using a magnifying glass to read words that we may not even understand.
And so it goes....