“In-network” vs. “Out-of-network” providers

I woke up this morning to a surprise medical bill in my e-mail inbox for a sick visit I paid to the doctor last October — that’s almost a year ago. I was surprised given that I knew my insurance should have been billed a long time ago, not to mention the co-pay was paid on the spot. After looking at this three-figure bill in shock, I visited my primary care doctor’s website to discover that they no longer accept my insurance, which didn’t really make a lot of sense because the last I checked when I visited last year, they did accept my insurance. So now I’m getting penalized for this? Their website says that they will still accept my insurance, but bill my insurance as an “out-of-network” provider. The entire concept of “in-network” vs. “out-of-network” has always driven me crazy in my adult life, as what… this is basically doctors’ and hospitals’ ways of making the most money possible by signing with insurance companies that will give them the best deal. From a capitalistic standpoint, that makes sense, but from a patient planning standpoint in terms of how to choose a doctor where your insurance is going to cover the bulk, if not all, of your bill, this is a complete nightmare, and part of the reason I’m sure that people hate visiting doctors period.

In the end, it was a mistake, and my doctor texted me to let me know that the bill was sent in error and to disregard it. But I still got mad about it. I got mad being reminded how senseless and difficult our healthcare system is, especially given how much it costs. And I also got frustrated knowing I could no longer see this doctor given that she doesn’t accept my insurance anymore. Now, I need to find a new primary care doctor, which makes me sad given that I really liked this one. It’s like finding a new friend — takes too long and is arduous and sometimes painful.

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