This video will help you learn about out of network insurance at Memorial Sloan Kettering, MSK. Out of network is a phrase you have probably heard before about insurance plans. When a hospital, doctor, or other healthcare provider has a relationship with your insurance company, they are considered in network. Out of network means that the healthcare provider does not have a relationship with your insurance company. What this means for you and how much you will need to pay for your care can depend on a few things.
First, it's important to know that you may still be able to come to MSK for care, even if your insurance plan considers MSK to be out of network. Some insurance plans include out of network benefits, which means your insurance plan will pay for care that is provided by doctors and healthcare professionals outside of their network. The big difference is that your out-of-pocket costs, the amount you need to pay yourself, could be higher.
Next, there's a process you need to follow before you can make an appointment at MSK if your insurance considers MSK to be out of network. Your primary care physician, or PCP, will need to write a referral for you, telling your insurance company that they recommend you come to MSK for care. Then, your insurance company will create an authorization. An authorization is permission from your insurance carrier to receive care from a doctor that is not in your network.
Once your insurance carrier authorizes your treatment at MSK, you can schedule your first visit. After that visit, if you and your MSK doctor have agreed that you would benefit from continuing your care at MSK, your insurance company will need to give you an additional authorization before you can continue. MSK's Patient Care Advocacy Program, or PCAP, will help you with the authorization process. If your insurance company denies the authorization, PCAP staff will work to appeal the decision.
Our team works together to resolve insurance issues as quickly as possible so that you can move forward with your care. For more information about how MSK can help you pay for the cost of your care or for more information about insurance, visit our website at mskcc.org/insurance-assistance. You can also call the Patient Billing Services staff at 646-497-9176 from Monday through Friday between the hours of 8:30 am and 5:30 pm. We are here to help.