Cost of Out of Network Care under the New Health Care Bill

Insurance companies can no longer pay less for emergency care at “out of network” hospitals — the hospitals with which they don’t have contracted rates. The provisions go into effect for every health plan issued after Sept. 23.A bill from an put of network hospital would not be lower but would remain the same, the difference would be that your insurance would cover the exact amount that they would have covered for an in network hospitals.

The insurance companies contract with hospitals and negotiate a lower price for procedures.  The cost is usually 75%  less than what the hospital would charge someone without insurance.  Hospitals that are out of network will charge someone like they do not have insurance.  The insurance company would always pay less for out of network visits.  As an example, if you had an emergency visit that would normally cost $20,000, however with the in network contracted rates the cost for the visit is $5,000. For in net work the insurance company would pay 80% assuming you would have a 20% deductible.  If the hospital was out of network your insurance only covers 60% of the contracted rate, $3,000.  With the new law, they are required to cover $4,000, like they would have covered with an in network hospital.  You are still responsible for the remaining $16,000.

Sure this is a little help but certainly not enough.  When looking for a plan, don't just go for the cheapest rate, that plan may not be suitable for you.  Find out what plans are accepted at you local are hospitals, urgent care facilities, and your doctors.  You may end up paying a couple of extra bucks, but in the long run, you would could save a bundle.  Your broker should be able to help you determine the right plan for you.