Many health insurance companies have agreements with health care systems like AHN that allow their members to pay for the care they receive at predictable rates.
Some health insurance companies choose not to contract with AHN or tell their members they can go wherever they want for care. This means that they do not have a specific agreement with AHN that sets negotiated rates for services. This is also called a non-contracted plan.
If you have non-contracted plan and get care from AHN, we'll help you understand how much you may pay for care and how your coverage works.
A non-contracted plan means your health insurance company does not have a specific agreement with AHN to pay a specific amount for any care you receive. If you have a non-contracted plan, your health insurance may contribute a lower amount or nothing at all toward the cost of your care. This is often referred to as going out of network for your care.
The best way to confirm if you have a non-contracted plan with AHN is to contact your health insurance company directly. When you call, ask if the specific AHN location (e.g., Allegheny General Hospital) and your provider are considered in network for the services you need.
Sometimes, your provider may be in network with AHN, but the hospital or facility where you get care (like surgery, imaging, or lab tests) is out of network. This is because some insurance plans have separate contracts for providers and facilities. It's important to always confirm if both your provider and the facility are in network for the care you need.
The most common non-contracted plans are:
You can still get care from AHN even if your health insurance provider is not contracted with us.
You can usually request an SCA if:
Our team will help you pursue an SCA with your health insurance plan. Getting approval for an SCA is not guaranteed, since it often depends on your medical needs and your insurance plan's policies.
Follow these steps to start the process of securing an SCA:
It's important to remember that the first cost estimate you received may change based on how the negotiations go with your health insurance company. If AHN and your insurance company don't reach an agreement before your scheduled appointment, your care may be delayed, postponed, or even canceled.
Without an SCA, your insurance plan may not cover any portion of your care, and you will be responsible for the full cost. If this happens, we'll work with you to understand your estimated out-of-pocket costs. We may ask you to pay the amount owed before you receive care.
AHN has financial assistance programs that you may qualify for. Our financial counseling team can give you more information and help you explore your options.
If you have other questions that we didn't answer here or need help navigating your insurance coverage, please call AHN Patient Cost and Estimate Services at 833-759-5500.
