When it comes to health insurance talk in and out of network is going to be one of the most commonly used terms. This is also one of the most important terms to understand. Knowing the difference between a provider being in network or out can be the savings of a few thousand to hundred thousand dollars.
(In network) A participating provider be it a doctor, hospital or another type of provider who works directly with your health insurance to accept the negotiated discount rate. An example would be a doctors office charging $150 for a visit, your approved amount from your insurance is $90 saving you $60.
(Out of network) Out-of-network means the complete opposite of above. A doctor or physician does not have a contract with your health insurance plan provider. This can result in higher prices. Some health plans will not cover care from out-of-network providers at all, except in an emergency.
So how do you find providers that accept your insurance? Check your insurance companies website as many will post what providers accept them. You can also contact the doctor or provider you want to see and ask if they accept your insurance as well. Calling and asking is not uncommon in this space, so don’t ever feel bad when you need help finding a provider. It’s someone’s actual job to help you!