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Paying For Your Procedure Out Of Network

The reasons you choose PPO health insurance over the HMO option include making medical procedures more accessible and having more control over your healthcare decisions. If you have a PPO plan, you do not need a referral from your primary care physician in order to see a specialty physician. You will likely pay a higher premium when selecting a PPO plan, which allows you and your physician to determine what is best for your plan of care. But this benefit gives you the option to go to facilities that are out of network with your insurance carrier.

Going out of network doesn’t mean your services will cost you more

If you utilize your out-of-network benefits, it does not mean that you will be

responsible for additional out-of-pocket (OOP) expenses compared to an in-network facility. New laws require price transparency from medical facilities in order to prevent surprises when you receive your bill. These laws also require all facilities to publicly disclose pricing. This information will make it easier for consumers to shop and compare prices across hospitals and estimate the cost of care before selecting a facility.

Houston Physicians’ Hospital discloses our prices for healthcare services

The new price transparency laws require that healthcare facilities provide clear, accessible pricing information online about the items and services provided at the facility.

However, it is not likely that your insurance carrier will recommend that you price compare in- network and out-of-network rates to determine your OOP responsibility. Houston Physicians’ Hospital helps you compare out-of-pocket fiscal responsibility for your procedure or services through our Price Estimator page.

Houston Physicians’ Hospital prevents “extra” or balance billing

At Houston Physicians’ Hospital, we provide every patient with a Facility Fee Service Agreement signed by both the patient and a hospital employee. This document is added to your medical record and it outlines the out-of-pocket costs that you are responsible for prior to services being provided.

Some out-of-network facilities bill patients for all charges that are not paid for by their insurance carrier. This is called “balance billing.” Houston Physicians’ Hospital eases our patients’ fears regarding this type of billing by completing the Facility Fee Service Agreement prior to the date of service. This upfront disclosure guarantees that you will not receive an additional bill from us.

Why top-rated physicians choose Houston Physicians’ Hospital:

  • We put our patients’ health before any insurance companies’ network status.
  • We are one of only four hospitals in the Houston area with a five-star rating for patient experience from Centers for Medicare & Medicaid Services (CMS).
  • We have a .13% infection rate.
  • We outperform every competitor in the area on CMS Hospital Compare.
  • We are recognized for patients having better outcomes while maintaining high patient safety standards and providing cost-saving measures.

Helpful Links

How to Get the Most Out of Hospital Price Transparency

CMS Completes Historic Price Transparency Initiative

Houston Physicians’ Hospital Price Estimator