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The Most Important Question You Should Ask Before Heading to the Doctor

Been to the doctor lately?

In this era of “sort-of insurance,” where so many are walking around with health coverage in theory only, even routine doctor’s visits have the potential to break the bank of regular Americans. It wasn’t always this way, but an ever-worsening financial climate for health care has made it such that even the most basic of health services can end up feeling like a sucker punch to the wallet.


Still, while there isn’t always a good answer to avoiding these expenses, there’s one simple thing people can do a lot more of to ensure their bills are as low as reasonably possible (besides avoiding the doctor altogether, of course): Namely, take steps to be certain that the doctor they plan to visit is an in-network provider.

According to an article over at CNN Money, it turns out that one of the biggest “gotchas” people face after a visit to the M.D. comes about when they learn - usually from the sticker shock that comes with reviewing the bill they receive in the mail - that they had visited an out-of-network provider for services.

This is something that happens very frequently. Here’s where people tend to get confused: When they call a doctor, they often ask the office manager or receptionist, “Do you take my insurance?” Where patients often run into trouble is that the staff member answering that question isn’t discerning between the doctor merely accepting their insurance, and the doctor specifically being an in-network provider, which is typically what the caller is really wanting to find out.

Being an in-network provider means the doctor has a contractual relationship with the insurance company preventing him or her from charging any more for a service than the amount already agreed-to by the insurer and the physician.

However, when you have care administered by an office that does no more than “accept” your insurance, the doctor is free to charge his full, regular rate for the service. Insurance will likely pay something, but because the doctor charged his full rate, and not the capped or discounted rate he would charge as an in-network provider, the patient is on the hook for a much higher balance.

Orly Avitzur, medical director at Consumer Reports, tells CNN Money that “if you go to Dr. Smith and he doesn't participate in your insurance plan, then he can pretty much charge whatever he wants.”

You know what to do. As you’re going through the process of selecting a doctor, call the office first to be sure that the physician is an in-network provider, and get out of the habit of simply asking if he “takes your insurance.”

Of course he takes your insurance. But now you know that might not be nearly enough.

By Robert G. Yetman, Jr. Editor At Large