What expats need to know before choosing their health insurance plan
November • 5th, 2019
by Expat in the City Team
In-network & out-of- network - why does it matter for expats in Germany?
Foyer Global Health is shedding light on the reasons why being covered by in-network providers is clearly not benefiting expats, and why freedom of choice should be the primary option.
What are the key differences between in-network and out-of-network covers?
Private health insurance companies offer all sorts of plans. Starting from the most basic cover and going as far as tailormade insurance schemes. Most insurers have built a provider network, namely a group of healthcare providers who make an agreement with the insurance company, and can treat the insured based on a pre-determined fee schedule. They can be doctors, hospitals/clinics, laboratories, primary care or specialist physicians, and even pharmacies that can provide treatment to an individual, meeting the minimum quality standards.
When an insured person is charged with a medical bill, there are two possible scenarios: either the insured has to pay the bill directly and then asks for reimbursement, or the insurance company can directly pay the medical care provider. But in many instances, the expat might be charged for some out of pocket cost. For example, if he chooses an out-of-network provider, then the reimbursement from the insurer is unlikely to cover the entire medical bill. It will depend on coverage restrictions, and on whether he chooses an in-network or out-of-network provider. Some plans only cover care in-network, while some can cover both. In general, a Health Maintenance Organisation (HMO) does not cover out-of-network care (except emergency); Preferred Provider Organisation (PPO) allows you to pay less if you see in-network providers and without referral for out-of-network providers, whereas Point of Service (POS) requires that you get a referral to see provider outside of the network.
Another important point is that some providers can accept your insurance plan, but that does not mean in any way that they are part of your insurer’s network. It is most important to carefully choose them and therefore you should always check the network directory, or to directly call the provider about his status. But please bear in mind that, although this information is available on the insurance company’s website, it can happen that the provider database is out-of-date.
That is why you need to be fully aware about what is included and what is excluded within your plan so that you are less likely to choose the wrong internal health insurance provider.
Why in-network providers is definitively not the right option for expats
Going to an in-network provider means that the cost is usually slightly lower (the doctor will not bill you the difference, you pay lower copays and coinsurance). However, the downside of these cost-savings measures should not be neglected. If there is a specific doctor or referring physician you want to visit, make sure that he belongs to the list of providers. Going to an in-network provider (a hospital for example) doesn’t mean that all doctors working there are included in the network.
You should be careful when choosing a plan because some can charge you more if you go to an out-network company.
Medical providers also have an agreement with the insurance company to maintain certain financial stability. They have their own financial interests, so they will possibly try to make you stay longer at the hospital to increase their margin. In other words, business can take precedence over patients’ well-being. On the other hand, insurance companies would make sure that you will not go for an out-of-network provider by setting high deductibles.
Here is a real-life story from one of our clients. He used to be part of a company group contract with his previous insurer and it was in-network based. He was working as an electronic engineer on a cargo ship, travelling across the world for months. One day, he woke up with terrible abdominal pain and had to be brought into the closest US based clinic, which was in his company’s insurance network. Several tests were performed and the doctor decided to give him an antibiotics treatment. His condition gradually improved, and he expected to be able to leave the clinic after just a few days. But the doctor insisted to do more tests and he started to become suspicious about the whole situation. He spoke with some other people that had already stayed there for long and they explained him that doctors were doing everything possible to keep patient for as long as possible so that they would get the maximum money out from the insurance companies. That is precisely when he realized that he had already been there for several weeks, for no medically valid reasons.
This story is a good example of the conflict of interest which lies within in-network partnerships. Insurance companies negotiate aggressive pricing from their medical partners, and in return doctors and hospitals need to have people treated for a longer period of time so that they can keep the same level of profitability. Many international health insurers are making their plans more cost attractive by lowering medical cover to a basic level, which is thus resulting in clients being underinsured, which means that it can get really difficult when one needs to see different specialists in order to have all the needed healthcare treatments. It is worth noting that, should you be living in a rural area for example, the in-network doctors and hospitals might be located far away from your home as the providers available in your neighborhood could be limited. Expats often need a broad range of medical treatments and specialized care which are not compatible with the in-network plans.
Here are 5 key questions you should ask yourself before subscribing an international health insurance plan:
- What exactly is covered and not covered?
- How good is the value for money compared to what I expect for my cover?
- What are the overall limits of reimbursement?
- Can I freely choose the medical provider I want, and still be fully reimbursed?
- How transparent is my insurer about the providers they recommend me?
Foyer Global Health makes no compromise with freedom of choice and transparency. We teamed up with Medihoo to grant our clients access to over 4 million health care providers, all over the world. We firmly believe that our clients are smart enough to make the right decision and choose the doctor or hospital that is best suited to them. We simplify the work of identifying a medical provider without jeopardizing the confidence people should have when selecting the person or facility that will provide the needed treatments. For both impatient and outpatient treatments, you have the freedom to choose your healthcare provider, no questions asked.
Learn more about Foyer Global Health Insurance here