How to Save Big by Confirming In-Network Providers for Scheduled Procedures

Have You Ever Been Blindsided by Medical Bills?

Picture this: you get one procedure done, and suddenly you’re drowning in four different bills. The never-ending flow of medical expenses can be overwhelming, especially when out-of-network providers sneak into the equation.

Understanding the difference between in-network and out-of-network providers can save you a fortune. Here’s how you can take control and avoid those nasty surprises.

Why In-Network Providers Are Your Best Friend

Insurance companies set contracted rates with in-network providers, which include hospitals, doctors, and medical facilities. This means:

• In-Network Providers: Agree to specific, discounted prices for services.
• Out-of-Network Providers: Can charge more (often much more!) because they aren’t bound by any agreements with your health plan.

If these terms make your head spin, don’t worry! Check out my free training: "3 Secrets to Confidently Save on Medical Bills" for a free crash course that includes these terms!

My Go-To Strategy for Confirming In-Network Providers

Before any scheduled procedure, I follow these steps to ensure every provider involved is in-network. Here’s an example from when my daughter needed an endoscopy:

Step 1: Identify All Providers Who Will Bill You

Ask your main provider for a list of everyone involved in your procedure, including:

• Anesthesiologists (billed separately)
• Facilities (e.g., hospital or outpatient center)
• Pathology Labs (for testing biopsies)

Make sure you get their name, NPI number, address, and phone number from the main provider (in my case, the GI doctor).

Step 2: Call Your Insurance Company

Provide the information for each provider and confirm they’re in-network. Be specific! For example:

• GI Doctor (main provider)
• Anesthesia Group
• Facility
• Pathology Lab

Let your insurer know the procedure details and confirm their network status.

Step 3:  Check If Preauthorization Is Needed

Ask your main provider for the CPT code (procedure code) and verify with your insurance if preauthorization is required. If so, request your provider’s office to initiate it before the procedure.

Step 4: Confirm Coverage Details

Use the CPT code to ask your insurer:

• Is the procedure covered?
• Are there any limits on how often it’s covered?
• How much of your deductible or out-of-pocket max have you met?
• Will you owe a co-pay or co-insurance?

Bonus Tips for Smoother Billing

• Always get phone numbers for the additional providers to contact them directly. They will know if they have a contract with your insurance plan or not, but I like to confirm with my insurance company myself too.
• Request a fair-value estimate for your procedure to anticipate costs for the procedure (this can take a couple weeks to get, so be diligent in following up with your requests if you choose to request estimates).
• You won’t be able to know everything that will get billed unless you request for a fair value estimate (which again will just be an estimate and is subject to change). I just checked for the main procedure code for our coverage and was comfortable with that!

Take Charge of Your Medical Bills

Don’t let the spider web of U.S. healthcare rules trip you up. These steps will help you avoid out-of-network pitfalls and keep your medical expenses under control.

Still feeling lost? My online course breaks down health insurance basics and walks you through real-world billing examples so you can save thousands. Check it out here!

Take control of your health—and your wallet!