What are out-of-network fees?

In the insurance industry, the term out-of-network refers to a medical care provider who has not been authorized by your health insurer. This doesn't reflect anything about the quality of out-of-network care, it simply means that a medical provider is not part of your specific insurer's covered "network" of providers.

Reasons you may choose an out-of-network medical provider include emergency situations or for the specialized services they provide. While most big insurers will still give coverage for out-of-network fees, they usually reduce the amount of benefits that they will pay in such cases.

Issues with out-of-network care have arisen lately due to a practice known as UCR rate reductions. This can occur when an insurer will intentionally underestimate the average cost of medical fees. By doing this, insurance providers have been shortchanging their customers on the benefits they deserve.

For instance, by estimating the cost of a $300 procedure at $225, an insurer will only pay benefits on a percentage of the $225. This leaves medical patients with the responsibility of making up a bigger difference in the bill. This has been a common occurrence in recent years with regards to out-of-network fees. In response to this practice, class action lawsuits have been filed against big insurers throughout the United States.

For more information on out-of-network fees and insurance rate reductions and overcharges, visit our library.

The attorneys at Phillips & Garcia will fight for your rights in your health insurance class action lawsuit. We are committed to protecting your best interests and helping you collect the damages you need and deserve to move on with your life. If you have been treated unfairly or been a victim of insurance overcharges, contact Phillips & Garcia today to schedule your FREE legal consultation - (877) 892-5620.