What is the benefit of using an in network provider?
It is encouraged to stay within the Humana network to ensure you are maximizing the most from your benefit plan.
You may receive a bill for services from non-network providers that can be higher than the maximum allowable fee. In addition to deductibles, copayments and coinsurance, you can be responsible for the difference between the maximum allowable fee and the amount the provider bills for the services. Any amount you would pay to the provider which is more than the maximum allowable fee, does NOT apply to the out of pocket limit or deductible.
The maximum allowable fee is defined in the benefit plan summary/certificate as:
•The fee most often charged in the geographical area where the service was performed;•The fee most often charged by the provider;•The fee which is recognized as reasonable by a prudent person
Very helpful. Thanks!
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