What if I have in-network and out-of-network expenses?

I use both in-network and out-of-network providers for healthcare (in-network for my wife's pregnancy and out-of-network for a condition my son is having corrected). There is a $3000 cost that will be applied to my out-of-network deductible (which is a $6000 deductible), but the in-network deductible is $3000. Do I have to meet both deductibles separately or do they overlap (which would mean I would no longer have an in-network deductible to meet?).





Thanks

What if I have in-network and out-of-network expenses?
Normally you have to meet both deductibles independently.





More importantly - when you move to your "out of network" tier - the providers are no longer tied to a contracted rate for the procedure. Make sure you discuss with your health care provider the following:





Mr Provider - I realize you are not in network and therefore you do not have to abide by any contracted rates, will you accept my insurance company's payment as payment in full?





You need to discuss the above with your out of network provider because he can legally "balance bill" you. In other words he can charge you the difference between what the insurance company pays for and his actual charges. Discuss it with him - most providers negotiate these days.





Hope this helps
Reply:It depends upon the particular plan you have.





Some employer groups set up their policies so that the in and out of network deductibles count towards each other. (Same goes for out of pockets.) Some employer groups set them up so that they accumulate separately.





The only way you are going to know for sure is to call your health insurance company - they'll be able to answer that question.





(I've seen thousands of benefit plan designs, and its definitely more common that the in and out of network expenses accumulate together. Meaning, as you put it in your question, that they "overlap." But...you need to call and verify your specific policy for sure. Its the only way to be certain.)
Reply:depending on your plan, the deductibles may be seperate they may not be. call the customer rep number on the back of your insurance card and they will be able to tell you for sure.
Reply:Both deductibles have to be met separately. There is an out-of-pocket max, which is usually more than the in and out network deductibles combined.
Reply:The deductibles should overlap. Most policies also combine the deductibles when you're using both in and out of network, so it will help with your out of pocket expenses, as well.
Reply:There should be a "maximum out of pocket" for both the person, and the family. Once the max out of pocket is reached, for a person, or for the whole family, you don't have any more deductible to pay.

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