In-Network vs. Out-of-Network

What’s the difference?

When our office is “in-network,” it means that our office is contracted to provide services and materials in accordance with a set schedule and program.  As an “in-network’ provider, we will fulfill and follow the obligations and protocols set forward by the plan.

At times, however, it becomes difficult for our office to remain “in-network” for a large number of plans at the same time; or specific plans obligate us to compromise the excellent and personal services which have been a hallmark of our office for many decades. In either of those instances, we move “out-of-network.”

When we are “out-of-network” for your vision plan, you are welcome to continue to receive your care at Fig Garden Optometry and your plan will (typically) allow you to continue to see the provider of your choice. However, when visiting us as “out-of-network,” the vision plan pays you, the patient, instead of us, the provider, for the amounts that are their responsibility. When that is the case, your responsibility with our office will be the fees for services and materials that other patients who have no vision plan experience.  Then, to receive a reimbursement from your plan, you would be required to send in paperwork to the benefit plan and wait for reimbursement after the fact.

The amount that the benefit plan will reimburse a patient seeing an “out-of-network” doctor will vary from case to case, employer to employer, and plan to plan.  If you would like us to provide an estimate of your “out-of-pocket” costs as an “out-of-network” patient compared to a prior visit when we were “in-network,” please feel free to contact us.

 

– The Team at Fig Garden Optometry