Should I Use Non-Preferred Providers With My FEHB Plan?
You face far higher costs if you use non-preferred providers. Plans not only charge you more for deductibles, copayments, and coinsurance, but also require you to pay the entire cost above the rate the plan sets as its allowance used in its network for a procedure. That rate is bargained with health care providers and usually varies by zip code and is not available to the public or to plan enrollees in advance. In general, we advise you to stay with preferred providers whenever possible. Remember that out-of-network cost-sharing percentages are valid ONLY if the non-preferred provider accepts the plans allowance (or, in the case of those over age 65, accepts the Medicare limiting charge). In most cases this will not be true unless you bargain, and the plan will likely pay less than half the bill. Half is better than nothing, but you should plan your health care to stay in-network wherever possible. There is almost always a wide range of high-quality preferred providers in-network.