Out of Network Doctors – Four Strategies That Work

In our last post http://wp.me/pLc5O-1L, we described this year’s significant changes to Out of Network coverage.  Insurance companies are reducing their out of network reimbursements from usual, customary and reasonable (UCR) to a percentage of Medicare.  If you will be continuing to use out of network doctors, here are four strategies to minimize the impact of using out of network providers:

1)      First the obvious.  Make sure that the plan you select will base their out of network reimbursements on UCR (not Medicare).  There are a few companies and plans in the market that still provide this.

2)      Consider a Health Savings Account (HSA) plan. These plans allow all individuals even partners to pay for the high deductible with pre-tax dollars through a bank account.  HSA’s are most likely to still use UCR as a basis for out of network reimbursement.

3)      If you must be on a plan that reimburses out of network claims at a percentage of Medicare, supplement it with an insured Executive Medical Reimbursement plan for select individuals.  If set up correctly, this can escape the nondiscrimination rules slated for Health Care Reform.

4)      Check out the website www.faircaremd.com.  It is a healthcare marketplace where you can shop for doctors and services.  It gives access to ratings, fair prices and reviews.  Even if you already have an out of network doctor, you can use this information to negotiate pricing based on knowing what other doctors charge.

In today’s changing health insurance market, you must strategize and custom design your health plan options to your healthcare spending.

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