How to cope with out-of-network medical providers

A friend asked a question about coverage with Highmark Blue Cross Blue Shield. This is not a carrier I run into often in the areas I work but it is a major insurance in the region. A description of Highmark Blue Cross plans and 2018 rates is published online.

The question was what to do when the doctors and hospital you use are not in Highmark’s network.

My first suggestion is simple and straightforward but not what some people would consider. This approach has worked for me in the past (with the same situation but with a different insurer). Simply ask doctors and providers in advance to accept the new insurer’s out-of-network as the full payment after yo pay your deductible. Facing the choice between accepting a lower insurance company payment or losing a patient, most medical service providers will choose the former.

Another option, especially attractive if an employer is involved, is to add a supplemental insurance like Core Health Insurance or other supplemental coverage like those at Smart Insurance Marketplace (see the “Supplemental Insurance” tab on the quotes page) that pays in addition to the primary coverage to boost the overall reimbursement.

A third option, although probably the least desirable, is to move to a non-ACA qualified plan. Short term medical insurance, good for up to 11 months, covers all doctors and hospitals equally. Some plans are listed on that same Smart Insurance Marketplace listed above. One downside is that these plans are not available in all locations. I find that sometimes people buy these short term plans using a temporary address while traveling which is a legal workaround to the limitation.


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