United Tiered plans

My employer is switching to UHC with a slight increase in premiums. The plan has tiers of network coverage. The coinsurance and copays are normal and on part with my current plan when using Tier 1 providers; let's call that normal coinsurance. They are more than double with non-Tier 1 providers (still in network). Let's call this the crazy coinsurance.

I am concerned that most of the time, I'd be paying the higher in-network crazy coinsurance. Like if I go to the ER and I select a Tier 1 facility, maybe none of the 10 doctors that see me are Tier 1. I've already explicitly confirmed that a Tier 1 facility isn't guaranteed all Tier 1 providers.

Is this accurate:

– I'd pay the crazy coinsurance rate for all the out-of-network doctors because of the No Surprises Act. Because the law just says they you won't pay more than in-network rates. The law's not going to force UHC to cover at the normal coinsurance rates.

– I'd pay the crazy coinsurance rate for all the in-network (but not Tier 1) doctors, because the No Surprises Act doesn't require UHC to offer the Tier 1 normal coinsurance cost-sharing, just "in-network" cost sharing.

Basically an ER visit would guarantee crazy coinsurance because there is no protection from the No Surprises Act if there aren't any Tier 1 providers available.

Likewise, if there are no Tier 1 audiologists, speech therapists, pediatric gastroenterologists, etc, I'd be paying crazy coinsurance for a non Tier 1 in-network provider, because UHC isn't under obligation to refer me to a provider at Tier 1 rates if there are none.

Accurate? Anyone experienced this? I did, but it was before the No Surprises Act.

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submitted by /u/3cansammy
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