I've been having some stomach pains lately, and really want to see a gastroenterologist. I am now covered by my universities PPO plan, can I go to any doctor and will they accept it?
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Yes, you can go to any doctor. However, you need find a doctor in the network if possible. If you go to a doctor that's in the network all you'll pay for the doctor visit is the co-pay. Depending on the policy you may also have other expenses such as lab work. When a doctor is in the network they agree to accept a certain $ amount for a procedure which in most cases is less than the doctor would normally charge. For a simple example; most specialists in my area charge around $200 for a basic visit. The amount they agree to accept from the insurance company is around $120. You'll pay the co-pay for the specialist, usually around $40, and the insurance company will pay $80. If you go to a doctor that is not in the network the doctor does not agree to accept the same $ amount as an in-network doctor. Also, you'll have to pay the entire charge first and then submit the bill to the insurance company. So to use the above example you'll pay the doctor the $200. You'll then submit the bill and the insurance company will reimburse you $80.
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