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Health plans have a specific group of doctors, dentists, pharmacies, hospitals, and other healthcare providers you can use at a contracted, in-network price. This is known as your network. The LifeWise networks are called LifeWise Preferred and LifeWise Connect.
Since you pay for part of the costs of your medical care, it's important to know that you will almost always pay less with an in-network provider compared to an out-of-network provider. Services from out-of-network providers may cost more, or may not be covered at all by your plan.
One danger of using an out-of-network provider is balance billing. Your health plan has a set rate that in-network providers can charge for services and procedures called allowed amounts. An out-of-network provider is not obligated to charge you the allowed amount.
So, if you have a procedure with an in-network provider who usually charges $200, but the allowed amount is $150, you will only be charged $150 for the service. The doctor writes off the other $50.
If you have the same procedure with an out-of-office provider, the provider can balance bill you the $50. Your LifeWise plan will only cover the allowed amount (less copy and deductible).
It's important to know when visiting an out-of-network provider that you can be charged out-of-pocket expenses (costs not covered by your health plan), including your deductible and copay. Out-of-pocket expenses for out-of-network providers often do not apply to the annual out-of-pocket maximum. Your out-of-pocket maximum refers to the most you could pay during a coverage period for your share of the costs of covered services before your plan pays 100 percent of eligible expenses.
Out-of-network expenses could include: lab work, durable medical equipment (wheel chairs, orthotics, and braces), cpap (breathing machines), referrals to specialist, radiology (x-rays, ct scans, and MRIs), and physical therapy.
Confirm with your provider that the services you are receiving are in-network to avoid higher out-of-pocket costs.
If you have a doctor you like, use the Find a Doctor tool and filter by the network name associated with the plan you're interested in. You can search for your doctor or clinic by name.
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