The Doctor I Need Is Out of My Network
If you need care that is unavailable within your provider network, contact your insurance plan to learn what your options are and how to request prior approval to see an out-of-network provider.
Depending on your plan type, you may have out-of-network benefits that could still cover the cost of the care, just at a lower rate than if you had gone to an in-network facility. Some plans to not offer any out-of-network benefits, but still may authorize you to go out of network if you meet certain criteria.
In order to get an out-of-network approval, you must be able to show your insurance plan that there are no in-network providers able to provide the specialized care you need. Ask the provider for a billing summary showing the amount you will be responsible for if you receive care outside of your plan’s network.
