Stay in Humana's Network to Avoid Extra Costs | Humana

Today’s question: how can staying in-network help me manage my healthcare costs? The simple answer is, when you stay in-network, you end up saving money and avoiding balance billing. See, in-network doctors and in-network medical facilities have agreed to a predetermined rate with Humana for every procedure, from broken arms to doctor’s visits to major surgery. So, when you see a doctor or have a procedure, your health insurance pays them the agreed upon rate. That’s good news for you because your costs will be lower too. But you have to make sure that all the care you receive comes from in-network providers. And it’s not always obvious. Let’s say Juan has his annual physical. He sees his family doctor, who is in-network. Juan makes his copayment. His insurance pays the rest. Juan’s doctor gets his agreed upon fee and Juan’s back to his favorite hobby, building solar-powered go-carts, which he loves.

Now, let’s say Juan’s friend Steve isn’t paying attention and accidentally knocks a toolbox onto Juan’s foot. Way to go Steve. Juan’s going to need surgery. He goes to an in-network hospital, his surgeon is in-network, but the anesthesiologist is an out-of-network provider. When the anesthesiologist billed for his part of the procedure, Humana paid him what out-of-network anesthesiologists are paid. This is less than what the anesthesiologist billed, and he may send a bill to Juan for the difference. This is called balance billing. Juan’s insurance paid the maximum allowed amount it pays for this out-of-network service. But because the anesthesiologist billed more than that, Juan had to pay out of pocket to cover the extra amount. There are a few things you can do to help avoid balance billing. First, talk to your doctor or hospital before every screening, procedure or test, to make sure that the facility or specialists you’re seeing are in-network. Second, review your benefits online.

Sign in to the MyHumana section at Humana.com and download your Summary Plan Description. Third, while you’re on Humana.com, you can use the Find a Doctor or Pharmacy search to find care providers, including doctors, hospitals, pharmacies, urgent care centers and more. Fourth, you can call the number on the back of your Humana insurance card and confirm over the phone that your provider is in-network. To sum it up, avoid unexpected healthcare costs by staying in-network every time you get any sort of medical care. So, until next time, stay smart and stay healthy.