Stick with doctors who take Oscar. Save money on health care. | hioscar Blog | Oscar
Stick with doctors who take Oscar. Save money on health care.
Your health care’s only covered if you see doctors who take Oscar. Save money by avoiding out-of-network bills.
Getting CareMember Resources
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Surprises can be fun, but there’s one kind of surprise we can all agree totally sucks - medical bills that aren’t covered by your insurance plan. When you get care, it’s important to go somewhere that accepts Oscar. Otherwise, you could get charged the full amount for the care you receive.
Most Oscar plans are EPOs (opens in new tab) (Exclusive Provider Organization), which means you usually have to stay in-network (opens in new tab) in order to have your health care covered. Here are some tips on how to avoid out-of-network billing surprises.
What is a network?
A health insurance network is the group of doctors, medical facilities, and labs members have access to as part of their insurance plan. At Oscar, we’ve curated a unique network (opens in new tab) to provide you with affordable, top-notch care and medical resources. Our network gives you access to high-quality, integrated care for hundreds of medical specialities.
What’s the difference between in-network and out-of-network care?
There are two kinds of health care you can receive: in-network and out-of-network. Out-of-network care is, for the most part, not covered by your Oscar plan, because these doctors and medical facilities don’t have an agreement in place with us. This means that when you receive out-of-network care, you’re responsible for the full cost. In-network care is covered by your Oscar plan, and is usually a lot more affordable.
Paying for out-of-network care can be frustrating, especially when your Oscar plan covers these services. But you can avoid most out-of-network bills by following a few important guidelines.
Before your next doctor’s visit, check with your concierge to confirm that your doctor accepts Oscar. If your doctor’s office is unsure about what insurance they accept, call or message your Concierge team, and we’ll you help confirm.
Use the Oscar app to find new doctors.
If you’re on the hunt for a new doctor, use the search feature in your Oscar account (opens in new tab) to access our directory of doctors. Filter by condition, reason for visit, doctor name and specialty. Within a doctor's profile, you can get more information on common conditions they treat, years in practice, hospital affiliation, and more.
Send your labs to any of our Preferred Labs.
Lab services are one of the most common surprise bills. While your Oscar plan covers preventive lab testing, they must be processed by our preferred partners which include BioReference, LabCorp, and Quest Diagnostics to be covered. The next time you’re scheduled for an appointment, be sure to ask your doctor’s office to send your labs to a Preferred Lab (opens in new tab) over any other in-network labs.
Use in-network radiology facilities.
If your doctor recommends imaging services (opens in new tab) like an X-ray, MRI, or CT scan, it’s important to go somewhere that accepts Oscar when you get them. Your doctor may prefer a certain radiology facility, but that doesn’t mean they accept Oscar. One way to avoid getting stuck with radiology fees is to use a facility affiliated with Oscar’s hospital network. This will help keep your cost-share down. Check with your Concierge to see which options for care may be the most cost-effective for you.
Coordinate your surgeries.
If you’ve got an upcoming surgery scheduled, be sure that the hospital facility, surgeon, anesthesiologist, technicians, pathologist,and any imaging and lab work done in tandem with the procedure are all in Oscar’s network. If you need help, call your Concierge team, who can help you through the process.
Read your bills and Explanations of Benefits.
Checking your bills and Explanations of Benefits (EOBs) (opens in new tab) is a great way to catch unfamiliar names and facilities to avoid surprise costs. Pathology and radiology services often require technicians (and sometimes additional providers) to review the outcome of the tests. We’ll send you EOBs for all services via snail mail, but you can also access this information on the activity timeline in your Oscar account. If you get a bill or EOB with a name, facility, or procedure you don’t recognize, contact your Concierge to get more information.
Know your out-of-network benefits.
We understand that there are some cases where out-of-network care may be necessary. All Oscar plans cover the following out-of-network services:
Hospital emergencies: If you require treatment at an out-of-network emergency room for an emergency (opens in new tab), we’ll cover your care until you’ve been discharged or admitted. Any out-of-network follow-up care will be your financial responsibility.
Surprise procedures: Certain procedures that require general anesthesia (like colonoscopies) may require follow-up testing or lab work that happens out-of-network. Some states, including New York (opens in new tab) and California (opens in new tab), have laws that protect you against surprise bills for services that occur under these circumstances. In these states, if you are under general anesthesia, your plan may cover some medically necessary procedures conducted at the time of the initial procedure (like polyp removal or biopsy), or care with out-of-network doctors who treat you when you’re put under.
Access gaps: We do everything we can to give you access to the doctors you need. But sometimes, health issues arise that require specialized treatment. If we can’t find an doctor who takes Oscar plans within a reasonable distance from your home, we’ll work with an out-of-network doctor to treat you for your condition.
Continuity of care: If your doctor leaves Oscar’s network, we may make a special agreement to cover your care with that doctor for a designated period of time so your treatment isn’t disrupted. Visit the Forms (opens in new tab) page to view the Continuity of Care guidelines for your state.
How to deal with balance billing and surprise bills.
If you receive out-of-network emergency care, you may get balanced billed. Balance billing usually happens when you receive treatment from a doctor who doesn’t take your insurance. While Oscar may agree to pay them our contracted rates for specific services, these rates can be less than the doctor normally accepts. They’ll then send you a bill for the difference between what Oscar paid and what their full price is.
Many states (opens in new tab) have balance billing legislation to help protect you from these surprise fees. If you receive medical bills for services you already paid for, or you’re getting billed by a hospital for services that Oscar has already paid for, contact your Concierge team immediately by phone (855-277-2755) or secure message. You can also send in a picture of any bills through the Oscar app. We’ll help you get to the bottom of why you’re being billed and work with your doctor’s billing office to make sure you don’t get charged for any services we cover.
