What are Out-of-Network benefits?

With most commercial insurances payers, you have the option to choose between In-network providers and out-of-network providers. In-network providers have negotiated rates with your commercial provider and out-of-network providers do not have a specific relationship with your commercial provider. HAE/PT is considered an Out-of-Network provider for all plans other than Medicare Part B. However, in many cases, HAE/PT can bill your insurance as an Out-of-Network provider at the same, or close to the same, out of pocket expense to you. HAE/PT would be happy to check your benefits for you and inform you of any potential financial responsibility for services.

What should I know about my Out-of-Network benefit?

You should find out if you have an out-of-network deductible, and if so, how much is left this year before you are eligible for reimbursement.

You should find out what the what percentage coinsurance or amount copayment you will be responsible for paying for your services after the deductible is met.

You should find out if you need a referral for services, if you have a maximum number of allowed visits and how to submit a claim for reimbursement.

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