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Different types of insurance plans have different rules about what is considered in-network and how much coverage they provide for out-of-network treatment. For example:

• HMO (Health Maintenance Organization) plans are limited, covering only emergency care out-of-network. Some of these plans might cover urgent care in certain cases, but non-emergency care is not covered.
• EPO (Exclusive Provider Organization) plans don’t provide any coverage for non-emergency care out-of-network.
• PPO (Preferred Provider Organization) plans offer coverage for out-of-network care, but the costs may be higher.
• POS (Point of Service) plans require you to choose a primary care provider to manage your care. They give you the option to choose in-network care or out-of-network care. However, out-of-network care may cost more.

How to check whether a provider is in-network

Before you get care from a provider or get treatments at a facility, find out which providers are in your health insurance plan’s network:

• Ask your health insurance company. Call customer service or log into your online account to look up a list of doctors and services that are in-network.
• Ask your doctor’s office. Talk with the billing department at your doctor's office and give them your insurance information. In many cases, they can tell you if they accept your health plan.
• Check coverage for all the services you need, including radiology, labs, pathology, or anesthesiology.

Coverage for some treatments can change, so it’s good to check regularly for any changes to in-network coverage.

If you’re not sure exactly what to ask, patient navigators, financial advisors, or social workers at your doctor’s office or treatment center can help.

What if the tests or treatments I need are out-of-network?

If you know some of your treatments will be out-of-network ahead of time, check with your health insurance company about your options:

• Ask if the services you need can be approved even though they are out-of-network. Your insurance plan may make exceptions if there are no in-network providers for the services you need or if the in-network providers are too far away.
• Ask for any documents you may need to fill out and submit for estimated costs or other information.
• If your case is denied, you have the right to appeal.

Some health insurance plans cover out-of-network emergency services. Others may cover some of the fees. Talk with your social worker or patient navigator for help finding more information.

How to find out what your out-of-pocket cost might be before treatment

Healthcare facilities, healthcare providers, and health insurance companies are required to give people information on costs before services are given.

If you have health coverage, you can get this information from your health insurance provider or your healthcare provider.

If the services you need are not covered by insurance, you can get an estimate from your healthcare providers before you receive services. To learn more, visit .

Many healthcare facilities offer cash pricing (a discount) for care services if paid upfront. This may be an option if you don’t have insurance or you choose not to use your insurance for certain services. It’s best to discuss this before the services are provided, when possible. Also, ask about payment options.

Does billing work differently for in- and out-of-network claims?

If you see an in-network provider, their office will usually bill your insurance company directly. After your insurance processes the claim, the healthcare provider will send you a bill for the amount your insurance didn’t cover, such as deductibles and copays.

If the provider is out-of-network or doesn’t take your insurance, you might be billed directly for the full amount. You would then need to submit a claim to your insurer to see if you can be paid back for some of the cost (reimbursement).

What is an Explanation of Benefits?

An Explanation of Benefits (EOB) is a document your insurance company sends you for each claim before you get a bill from your healthcare provider. The EOB will include:

• The services you received
• The amount your insurance paid
• The amount you may owe

It’s important to review the EOB so that if there are any issues, you can look into them before you get a bill.

Here is an usually looks like.

How do I avoid surprise medical bills?

Surprise medical bills happen when you get care from a provider or in a facility that’s out-of-network. Your health plan may not cover the services. You may get billed for full or partial amounts for the services. This could also happen if you went to an in-network provider without knowing that some of your care was provided by an out-of-network provider. Some services, such as certain tests or anesthesiology, may not be covered. Sometimes, surprise bills include balance billing with charges that your insurance did not cover.

A federal law called the No Surprises Act (NSA) helps to prevent surprise medical bills. This law helps cover emergency care and situations where you’re treated at an in-network hospital by an out-of-network provider, such as a radiologist or anesthesia team. In these cases, you should not be billed more than your in-network copay or coinsurance.

How to manage healthcare costs

These tips can help you manage your health insurance coverage and avoid unexpected costs:

• Keep your health insurance active and pay premiums on time.
• If you change insurance plans, make sure the new one starts before the old one ends. This include/content/cancer/ens when you switch to Medicare.
• Before planned treatments or tests, find out from your insurer whether you need prior authorization.
• If your finances are limited, ask your cancer care team for help from a case worker, financial counselor, or social worker. They may be able to help you understand your bills, find support, or set up a payment plan.
• Review each medical bill and EOB statement to make sure it looks correct. If something doesn’t look right, ask for an itemized bill and call your insurance provider.
• For any costs not billed directly to your insurance, be sure to submit claims or requests for reimbursement. Keep copies of all paperwork.

Which financial records need to be saved?

Cancer care can involve many providers, treatments, prescriptions, and bills. After treatment, you will probably have some kind of follow-up or long-term care plan. In addition to saving your medical records, it’s important to keep track of the expenses and payments related to your care.

Keeping a careful record of medical bills, insurance claims, and payments can be challenging. But it can help you track what has been paid, what you may still owe, and whether any bills or claims need follow-up.

If you can, ask a family member, caregiver, or friend to help you stay organized.

Here are examples of what to save:

• Keep all paperwork related to your claims, such as letters of medical necessity, EOBs, bills, receipts, requests for sick leave or family medical leave (FMLA), prescriptions, and correspondence with insurance companies.
• If you have other expenses related to your care, such as travel, meals, and lodging expenses during treatment, find out if these are tax-deductible by checking with the . If so, keep the original receipts for any of these non-medical expenses.

Store your records and copies of paperwork in a secure place. You might also scan the documents and keep them as digital files.

Need more information?

The following organizations may also offer helpful information. The 黑料大湿Posts Cancer Society is not affiliated with or responsible for these resources:

Triage Cancer
Phone number: 424-258-4628
Website:

Provides free education and resources related to health insurance, medical bills, employment, and disability.

Cancer Support Community
Toll-free number: 1-888-793-9355
Website:

Has a section about managing the cost of cancer treatment.

Livestrong
Toll-free number: 1-855-220-7777
Website:

Includes a section about health and disability insurance.

State Health Care Marketplaces – US Department of Health and Human Services
Toll-free number: 1-800-318-2596 (also in Spanish)
TTY: 1-855-889-4325
Website:

Provides information on the new insurance law, takes you through the steps of finding insurance, and much more. If you don’t have internet access, the phone number will connect you with your state’s marketplace.

Medicaid – US Department of Health and Human Services
Toll-free number: 1-877-696-6775
Website:

Your state social service or human service agency can give you the best answers to questions about your benefits, eligibility, and fraud.

Medicare – US Department of Health and Human Services
Toll-free number: 1-800-633-4227
TTY: 1-877-486-2048
Website:

Answers questions, provides literature, and gives referrals to state Medicare offices and local HMOs with Medicare contracts.

Department of Veterans Affairs
Toll-free number: 1-800-827-1000
Website:

For information on veterans’ medical benefits and whether you qualify for them.

Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)
Toll-free number: 1-800-733-8387
Website:  

For information on coverage of eligible families and survivors of veterans and military service members. The program is administered by the Chief Business Office Purchased Care (CBOPC) in Denver, Colorado.

US Department of Labor, Employee Benefits, Security Administration (EBSA)
Toll-free number: 1-866-444-3272
Website:

Information on employee benefit laws, including COBRA, FMLA, and HIPAA requirements of employer-based health coverage and self-insured health plans. Also has information on recent changes in healthcare laws.

Information for military reservists who must leave their private employers for active duty can be found at:

National Association of Insurance Commissioners
Toll-free number: 1-866-470-6242
Website:

Offers contact information for your state insurance commission (also called a state insurance department). You can contact your state insurance commission for insurance information.