Out of network
In our own words.
We are not a grocery store. We set the price of groceries at every store in your network, and we show it at none of them. Here are our plans. Here are the stores.
A store outside your network never agreed to our prices. So we pay it the least. We have paid it the least for years.
Paying a store the least makes your share the smallest. We noticed this some time ago. It is not in the brochure, and this is the first page it has been on.
In an emergency you may use any store, in your network or not, and your share is figured on the amount we call our median. A federal law says so. It has rules. They are in a manual. The manual is somewhere else.
You already know groceries are expensive. You have been shopping in network.
Please keep your membership. The protection lives inside a plan: with no plan there is no amount we call our median, and nothing for the law to hold us to. The smallest network at the lowest price does everything the law needs. Your coverage is in network. Out of network is cheaper than going to the food bank.
What do I really pay out of network?
The real answer
Under the No Surprises Act, for an emergency at any ER, or an out-of-network clinician at an in-network hospital or surgery center, you pay your in-network share, figured on the recognized amount — under the federal rule the QPA, what the plan calls its median in-network rate for the service — and it counts toward your in-network deductible and out-of-pocket maximum. The doctor may not bill you the rest.
Surprise billing: the law, state by state, and what you pay — on provern.org
Our agency made commercials about this that we did not approve: What does OON mean? · How do I get cheap healthcare? · all of them.
Thank you for choosing Standard Healthcare.