You need your knee fixed. Your orthopedist wants you to go to a facility that’s out of your network. You are miffed because this is going to cost you alot of money. Or is it?
Your benefits are 80%/20% in network and 60%/40% out of network. What does this gobbledegook mean? It means that your out of pocket responsibility is 20% if you go to an in-network facility and it means that your out of pocket responsibility is 40% if you go out-of-network. OK…SO? If the charge or the allowable billed amount of the in-network facility is $12,000, your responsibility is 20% of that, or $2,400. If the charge or allowable amount of the out-of-network facility is $3740 (our online price) your responsibility (40%) is $1496. What? You mean that your out-of-pocket expense for a surgical experience at the Surgery Center of Oklahoma is less than that at a big (not-for-profit) hospital? How can this be?
Why are the insurance companies determined to direct you (scare you) to a facility where you will be out of pocket more money? What could possibly motivate them to do this?
