Beyond the Mirror has both in-network and out-of-network providers to best meet the needs of each individual.
What is the difference between in-network and out-of-network providers?
An in-network provider is one contracted with your health insurance company to provide services to plan members for specific pre-negotiated rates. An out-of-network provider is one not contracted with the health insurance plan. In many cases, your insurance company will pay a percentage for services you receive from out-of-network providers. If you are choosing to bill as out-of-network or self-pay, Beyond the Mirror can slide our fees to best accommodate your needs.
Reasons for Choosing Out-of-Network Health Care
Sometimes you have no choice, or it just makes sense to choose a non-network healthcare provider. Under most of the following scenarios, you may be automatically eligible for or you can appeal for in-network coverage:
· Specialized care: If you have a rare ailment for which no specialist is included in your plan, out-of-network care may be crucial.
· Increase Quality of Care: If you want to see a practitioner that specializes in the issues that you are struggling with.
One Location: When choosing in-network you may find that you need to go to multiple locations to access all of the services you need. Out-of-Network coverage can be beneficial to access multiple services at the same location. Changing providers would jeopardize your health: If you're in the middle of treatment for serious or end-of-life issues, and your provider leaves the network, it may be in your best interest to continue that care by going out of network. You can appeal for continued in-network coverage, if only for a period of time or a set number of visits.
· Out-of-town care: If you need medical care while away from home, you may have to go out of network, but some insurers will handle your visit to a non-participating provider as if it were in network. However, in-network providers may be available.
· Proximity issues: If you live in a rural area and there is no primary-care provider within a short drive or if you require a specialist and none is nearby, your continued health may depend upon using a non-participating doctor. In these cases, many companies will cover the cost at an in-network rate.
· Natural disasters: Floods, widespread fires, hurricanes and tornadoes can destroy medical facilities and force people to evacuate to other areas in which they must seek health care. Sometimes, these patients may be eligible for in-network rates as part of a declaration of emergency by the state or federal government.
· Emergencies: In an urgent situation, you must seek the closest available help. Many plans make exceptions for out-of-network coverage during an emergency.
· Privacy: If you want to ensure that no third parties receive your PHI including diagnosis information. Choosing to self-pay protects your private information.
In-network Health Care means the practitioner you see participates fully with your health insurance plan and the copays, deductibles, coinsurances, etc specified on your health insurance card applies.