What is an in-network provider and why does it matter?
WHAT does in-network mean?
When a provider accepts your health insurance plan, they are considered an in-network provider. They are also referred to as a “participating provider”. If you seek care from a doctor or provider that does not accept your health insurance plan, this would be considered out-of-network.
Why does in-network matter?
Before seeking care, it is crucial to confirm if your provider accepts your health insurance plan, and if they do, what the costs are. It is important to note that if you need to see a doctor, dentist, get labwork, see a specialist, you must confirm that the provider is in-network so that you don’t receive a hefty bill in the mail later. If you seek care from an out-of-network provider, it is much more expensive and may not be covered at all by your insurance plan.
HMO vs. ppo networks
HMO plans are typically lower cost and a Primary Care Physician (PCP) is in charge of managing your care. HMO plans have more restricted networks and your PCP must provide referrals before you seek care from a different provider, like a dermatologist. Out-of-network costs for HMO plans can be very high. PPO plans are typically higher cost and you are able to seek care outside of your plan network and do not need to coordinate your care with your PCP. To read more about HMO vs. PPO plans, click here.
How do I find out if my provider is in-network?
Insurance carriers have provider searches that you can access to view providers near you that accept your insurance plan. You can also call the provider’s office directly and ask them if they accept your insurance, and their knowledgeable staff will be able to confirm. If you have trouble accessing a provider search or still require more assistance, reach out to your broker or benefits administrator for assistance.
This information is intended for information purposes only. Any reader understands that Apex Benefit Group is not providing legal advice, tax advice, or professional services. This article serves to offer practical information regarding the subject matter and is not a comprehensive resource.
If you would like to discuss your insurance needs with a specialist, please contact us today.
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