In most cases, there are good reasons to go out of network for your day-to-day health care. First of all, insurance companies place strict rules on their in-network providers. For example, in-network providers can't be paid without an office visit, so you're forced to come to their office for everything, even though evidence shows that office visits are required for less than half of primary care problems.
We've gotten so deep into the pit of arcane insurance rules that vary not only from one insurer to the next, but within each insurer based on the nuances of each employer contract.
I used to keep the 10x14"paper grids explaining co-payment policies from one insurer on one set of HMO product lines. I tacked it up on my 'wall of shame' and had fun asking patients to see if they could identify their co-payment.
These fun and games cost the nation $31B per year, averaging out to $68,000 per doctor per year.
As Alan Dappen MD points out in his blog post linked above, doctors going off the grid can charge less and provide better access because they're able to do what is right for their patients instead of living up to the insurer preferences that often run against the effective delivery of good primary care.
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