Explaining the cracks in the system, that is. My favorite is how generally, if it's an emergency, network issues cease to apply. You just go wherever's close. But "usual and customary" cost limits always apply.
There are doctors who exploit this hole, charging you up the rear when they're on emergency rotation at the hospital and they don't happen to be in your network. So, insurance company will only pay X amount, often leaving you stuck with the difference. And since doctors, particularly specialists, are not a dime a dozen, the hospitals have little recourse for discipline there. |
