Skip to main content

View Diary: Insurers widen profits by narrowing choice of doctors (96 comments)

Comment Preferences

  •  If you choose a PPO plan then there should be (1+ / 0-)
    Recommended by:

    coinsurance payments.  My plan will pay 50% to out of network providers.  So I can see any doctor I want.

    I've also noticed that my Grandfathered plan on the Individual market has a smaller network in the Blue Shield database than some of the big group plans.

    Congressional elections have consequences!

    by Cordyc on Tue Nov 26, 2013 at 12:58:41 AM PST

    [ Parent ]

    •  Be Careful (0+ / 0-)

      What will likely happen is that your insurance company will pay 50% of the "reasonable and customary charges" -- which does not equate to 50% of the bill charged by your out of network doctor, who is then free to balance bill you for the amount not paid by the insurance company. This is exactly what has been happening for years in states such as NY with very high-priced specialists. The insurance company uses zip codes or their own formulation to come up with "reasonable and customary charges" and it never equates to one-half of the physician or medical facility charge - leaving consumers with huge, unexpected bills.


Subscribe or Donate to support Daily Kos.

Click here for the mobile view of the site