(4-3-24) By January 1st, 2025, Parkview Health will no longer accept patients whose insurance is considered out-of-network.

What does out of network mean?

This phrase usually refers to physicians, hospitals or other healthcare providers who do not participate in an insurer’s provider network. This means that the provider has not signed a contract agreeing to accept the insurer’s negotiated prices.

Depending on an individual’s health insurance plan, expenses incurred for services provided by out-of-plan health professionals may not be covered, or may only be partially covered by an individual’s insurance company. Plans that cover out-of-network care are less common than they once were, but they are still available in many areas. They generally impose a higher deductible and out-of-pocket limit (or even no upper limit) when patients obtain care from an out-of-network provider.

And it’s important to understand that out-of-network providers can and do balance bill patients for the remainder of the charges after the insurance company has paid its share. In-network providers have agreed to accept the insurance company’s payment (plus the patient’s pre-determined cost-sharing amount) as payment in full, but out-of-network providers have not signed any sort of agreement with the insurer.

Parkview Health says the move is designed to “protect patients” from large bills that result from receiving care at a facility where their insurance does not work with.

David Jeans, senior vice president of payor, employer and health plan strategies for Parkview Health, in a statement-

“When health insurers or employers set up health plans, they select which healthcare providers and facilities are considered in-network. We realize that patients may not always understand which providers and benefits are contracted with their plan, which often creates confusion when they receive a bill for out-of-network care.”

“We encourage all patients to make informed decisions about their care, including selecting a health plan that best meets their needs and helps reduce their costs.”

The changes will be made across three phases starting May 1-

May 1, 2024 – Parkview Health will stop scheduling ancillary services — such as lab and diagnostic imaging — and elective or planned surgeries for out-of-network patients.

July 1, 2024 – Parkview Physicians Group will stop accepting new patients. Patients are considered new if they have not previously been seen by someone with Parkview Health.

January 1, 2025 – Parkview Physicians Group will only schedule patients with insurance that includes Parkview Health.

The changes will affect approximately 1% of Parkview Health’s patients and will not affect uninsured patients or those needing emergency care.