Each health insurance provider has its own approved network of doctors, as Carrie Feibel explains in a report for NPR. Additionally, most health insurance plans offered by the exchange Marketplace have distinctive networks of health care providers, according to HealthCare.gov.
Each health insurance provider has its own network of hospitals, physicians, pharmacists and other health care personnel, explains Feibel. This system lowers the cost of health care for patients who restrict themselves to health care facilities that are part of a network covered by their insurer.
Unfortunately, it is possible for a health care facility and its staff to be part of different networks, warns Feibel. This is because medical personnel such as radiologists, anesthesiologists and emergency room doctors operate independently and are not employed by hospitals. These professionals typically offer their services as part of practice groups that are independent of the facility from which they operate. This sometimes leads to situations in which patients visiting in-network medical facilities receive treatment from staff who are part of another insurer's network and are accordingly billed at the same rates as those visiting out-of-network personnel.
This arrangement is not only confusing for patients, but it also leads to significantly higher medical costs. To solve this problem, states such as Texas have developed a mediation process for select out-of-network medical bills. States such as California have gone a step further by outlawing separate billing.