Participating providers are health care providers who have an agreement with your insurance organization. Your insurance organization agrees to pass on “customers” to the provider and, in return, the provider accepts lower fees for its services. Your insurance organization verifies interested health care providers to ensure they meet certain quality standards. If the applicant complies with these standards, your insurance and the health care provider enter into a contract. To be sure, you should always ask each health care provider if they are responsible for your insurance organization as a participating provider. Are there unscrupulous suppliers out there who are going to play this little pun? Unfortunately, yes, it has happened more often than you can imagine. After receiving the co-payment from your insurance company, the DME provider submits the bill for the remaining $1750 (the 50% co-payment of $750 plus $1000 above the usual price). Since they are not contractual with your supplier, you are not protected against the fact that the Agency charges you the amount above what is considered to be usual and usual.color”firebrick” > non-parable suppliers may be as qualified as participating suppliers. So why use an ISP versus a non-betting provider? Since you used a non-contract or non-participating provider, your insurance organization is only responsible for 50% of the usual $1500, instead of the 75% it would have paid if you used a participating provider. The total amount paid by your insurance company is $750, half the usual price of $1,500.

You may think they will participate in your insurer by saying, “Yes, we will take your insurance.” It`s not true!!!!! This only confirms that they accept/accept payment from your insurance company and can submit their claim to your account with your carrier. This does not mean that they actually have a contract with your carrier. You may be wondering what will happen to the remaining $2,500. Will the surgeon expect you to choose the rest of the claim? The surgeon might want you to bring back the remaining $2,500, but under the contract, he or she is unable to “repay” the remaining money. Following the example of your ski accident, we will examine the requirements of the company that made your hose, wheelchair and dresser available to you (permanent medical equipment, also known as DME). Be careful if you ask a provider if they are withdrawing your “!!!!! In this example, you did not find a mandated physiotherapist near you. To be safe, you have contacted your insurance company`s customer service department and confirmed that there are no suppliers within a 30-mile radius. You inform customer service staff that you have identified a therapist you want to use. Customer service staff indicate that they will make an a-network recommendation for this therapist for a period of six months. During this period, your insurance agency pays 75% of the usual and usual price of the services provided. In other words, they pay the fees as if the non-par provider is a provider by.color”firebrick” > Without a contract, there is nothing your insurance agency can do to protect you. Please be careful! Here too, we will use the example of your unfortunate skiing accident.