Learn the cost of going out of network

Insurance companies negotiate standard rates when a hospital and its physicians are part of their network, but if you go out of network as with some indemnity plans, the fees can vary dramatically.

• Get cost estimates from the hospital and the physicians, and try to find out any incidental fees you can avoid.
• Research what portion your insurance will cover. Know that most plans will only cover a percentage of charges they consider "reasonable and customary." This may be a lot less than what the hospital and doctors charge; you'll be responsible for the difference. And find out if your insurance company will pay the entire "reasonable and customary" portion, or if you'll be responsible for some of it due to deductibles or co-insurance.
• Ask doctors if they are willing to accept your insurance company's payment for their services as payment in full, especially if they work in a hospital that's covered by your plan.
• Don't be afraid to negotiate with your insurer in advance. They may be willing to pay for a procedure at an out-of-network hospital, or performed by an out-of-network specialist, if there aren't any in-network options. Your physician should help you justify the necessity.

"Choosing to go out of network is a very personal decision," says Maura Carley, a health-insurance expert and advocate with Healthcare Navigation. "Understand what you're in for and make a conscious decision. If you go out of network you can't completely know what your financial exposure will be," she says. But if going out-of-network is the best decision and it's feasible, be prepared, and continue to ask questions about costs if new tests or procedures are recommended before and during your care.