When it comes to your out-of-network health care, or services administered by a provider who is not contracted with your insurance company, the more you know, the better. Easier said than done, right?

How to Negotiate a Medical Bill with Naviguard. When you receive a medical bill for an amount beyond your deductible, co-pay and co-insurance, it’s called a “balance bill.” Quite often, a balance bill is prompted by medical care that’s considered out-of-network, or services from a provider who doesn’t have a contract with your insurance company.

Helping to understand Out-of-Network health care is what Naviguard does. We have broken down some confusing aspects including deductibles, copays, and coinsurance.

It’s happened to so many of us: you get a medical bill that throws you for a total loop. It’s for a provider or a service that’s defined as “out-of-network”—in other words, not covered by your health insurance.

What is Out-of-Network billing and how do you avoid it? Naviguard breaks down what OON bills are and what to do when you receive one.

The No Surprises Act provides protections for patients who receive health care benefits from their employers or who are enrolled in individual health plans. For services that fall into these protected categories, providers will not be allowed to bill you for amounts higher than what you would pay from an in-network provider.

For employer-funded health plans, the NSA demands that significant requirements are met in provider/plan billing disputes. Check your health care plan for any restrictions on providers and other administrative particulars.

For health care providers, the No Surprises Act provides a clear process for resolving out-of-network payment disputes. When the provider and the health plan can’t come to an agreement, a neutral third party will determine the payment for a service.

Michael Wentzien of Naviguard and Lisa McDonnel of UHC explain in this podcast the implementation and affect of the 2022 No Surprises Act legislation.