DizBelle
DIS Veteran
- Joined
- Sep 10, 2003
- Messages
- 6,510
Ok, your all going to think I am a ditz, but I am young so I am still learning all this stuff.
So, our co-pay for the specialist was $35, our insurance agreed to pay $205, but the claim submitted by the DR was $513. So, we were only responsible for the $35. What happens to the other $273 that the dr is supposed to be getting?
If the doctor is "in network", your insurance company has a negotiated a rate for certain services. Basically, the doctor has agreed that he/she will accept payment of $205 for whatever it was they provided to you and that is the end of it.
The benefit to the insurance company is that they get reduced costs of services.
The benefit to the doctor is that they get more patients as the insured has a smaller pool of doctors from which to choose (to get the in-network benefit). You will most likely choose from among the doctors in the network rather than all of the doctors on the planet.