Submitted by Misssheilala t3_10knwth in explainlikeimfive
Azeranth t1_j5rwbzy wrote
Reply to comment by Misssheilala in Eli5 how can your doctor’s office accept your insurance but still be out of network? by Misssheilala
Generally the answer is sort of. They take your insurance information, and are not allowed to lie about being in network. That's insurance fraud and they get in big trouble.
They usually make you sign something agreeing to pay whatever insurance won't. This is sort of redundant, but you essentially are confirming that you understand that insurance may not fully cover your care. You should not have to sign this at an in network facility when undergoing non-elective care. Exceptions arise for emergency care where you sign on a blanket basis, because it's likely to overrun your premiums.
They are not legally required to tell you what the price will be and they are not legally required to honor the price advertised when they bill you. Importantly, they also can't just lie. They're bound by what's called "good faith". As long as they price they give you is honestly their best guess, they're off the hook.
Forcing medical providers, especially hospitals to publish and honor the price of their services not subject to insurance negotiation was a big part of Trumps healthcare reform initiatives, along with right to try and other misc small items.
Misssheilala OP t1_j5s3nbn wrote
They’ve never asked me to sign anything acknowledging they were out of network until today. I would have understood if my insurance changed (it hasn’t) or if they had dropped Aetna as a provider. When I asked them if they dropped Aetna they said they have never contracted with Aetna, which now I understand is different than excepting Aetna thanks to your first comment. All very informative and I appreciate your explanation!
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