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What happens if I see an out of network provider?

Question asked by communitymanager Moderator on May 18, 2016
Latest reply on Sep 17, 2019 by communitymanager

When you receive care from a physician in the network, you are responsible for the coinsurance amount and any applicable deductible or co-payment for each visit. However, if you choose to see a doctor outside of the network, you accept responsibility for a greater portion of the cost for your care. For the services of a non-network physician, your deductible and benefits are based on a reimbursement schedule established by Humana and agreed to by your employer.

If you  receive care from a non-network physician, you may find yourself in one of the following situations:

* The physician may decide to "write off" any charges not covered by Humana.
* The physician may bill you for a portion of the remaining balance.
* The physician may bill you for the entire balance.


Humana has no way of knowing whether or how much, you will be billed by the non-network physician who has provided your care. The billing decision is entirely up to the physician. Remember that you can get the best value from your Humana plan by choosing to seek care from in-network physicians. When you obtain care from physicians in our network, you potentially pay less out of your pocket for the provider's services.