Out of Network Providers
I am in the US. I am retiring in six months. I am also moving. I have the option to continue my employer’s health insurance and would like to do so until I am Medicare eligible. The insurance company Pacific Source. The plan’s network covers areas in OR, WA, ID, and MT. I am moving to WY.
Since I will be out of network, I called Pacific Source and asked how best to handle utilizing out-of-network providers. My preference is to spend my health care dollars locally, but I am not far from providers in MT. The Pacific Source rep said to get in-network benefits I would need to negotiate with each provider to have them “agree to the billing and reimbursement terms of the network.”
This seemed to me to be an odd statement. Since in-network providers are under contract, can out-of -network providers just randomly agree to the terms? I would think that dilutes the benefit of a provider being under contract.
I am expecting this to be more complicated than Pacific Source makes it seem. Mostly, I expect several rejections from providers. Maybe there will be a cumbersome process between the provider and insurer. Does anyone have experience with this situation?
