Out Of Network

FAQ: What If You Are Out Of Network With My Insurance?

When it comes to plan and network types, you’re looking at the type of health care services that are covered in your plan. As well as the doctors and facilities you are allowed to see. These can either be in network or out of network. Some plan types let you see any doctor at any health care facility. Other plans can limit your choices or charge you more to see out of network providers. 

The different plan types include HMOs, PPOs, POSs, and EPOs. Each plan type has a different amount of freedom for choosing healthcare providers.

Out Of Network

Health Maintenance Organizations (HMOs)

HMO’s are a type of health insurance plan that only allows you to see doctors within their network. This plan generally doesn’t cover out-of-network services, except in the case of an emergency. An HMO also requires you to choose a primary care physician to be eligible for coverage. The primary care physician helps coordinate your care. This means they must give you permission before seeing a specialist.

Preferred Provider Organizations (PPOs)

PPO’s are a type of health insurance plan that gives you better coverage for you to see the doctors within their network. You will pay less to see an in network doctor than you would an out of network doctor. You can still see doctors outside of that plan’s network, but you will have to pay more for those services.

Point Of Services (POSs)

POS’s are a type of health insurance plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. Think of a POS plan as a hybrid between an HMO and PPO. You are choosing whether you want to use HMO or PPO services each time you go to the doctor. Like an HMO plan, you have to choose a primary care physician, but you can pay extra to see non-participating providers, as you would with a PPO plan. POS plans also require you to get a referral from your primary care physician if you need to see a specialist for any reason.

Exclusive Provider Organizations (EPOs)

EPO’s are a managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network, except in an emergency. Unlike an HMO, you don’t need to name a primary care physician or get a referral to see a specialist, as long as you choose a ‘participating provider.’

A network provider has agreed to provide services to the plan’s members at a discounted price.

Contact Our Billing Department

As a courtesy, our Billing Department will verify your insurance benefits. If you do not have in network medical benefits, please speak with our billing coordinator to discuss self-pay options. There is no payment plan option for self-pay patients.

It is VERY important for each patient to know their individual benefits so unexpected balances do not occur. The Borja PT Billing Department files with many insurances that offer several different plans. Therefore, the patient must make sure their benefits are accurate.

For more information about our financial policy, click here.

About The Author

Jaime Curl

I've explored many different fields within physical therapy, including acute care and oncology at Troy Beaumont Hospital, elementary through high school levels in the Troy School District, and outpatient physical therapy. As the office manager and marketer, I am able to combine my love for health and exercise science with my people skills, all with a dash of marketing and personal training. My hobbies include spending time with friends and family, baking, crafting, and watching my favorite movies or tv shows.

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