Your insurance plan contracts with a number of doctors, specialists, hospitals, labs, radiology facilities, and pharmacies. These providers make up your network, and can sometimes be known as your insurance provider network or PPO network. It is generally best to seek care within your network and there are several benefits of going in-network for health care.
The top 5 benefits of going in-network are:
You save money
Providers in your network have agreements with your insurance company that save you money. These providers agree to accept your plan’s contracted rate as payment in full for services. This contracted rate included both your insurer’s share of the cost and your share.
Services are provided at a lower rate
Your plan may require higher co-pays, deductibles, and co-insurance for out of network care. For example, if you usually have to pay 20% of the cost of the service in-network, you may have to pay 30% of the cost out of network. Often, you will have to pay that as well as any difference between your insurer’s allowed amount and what the provider charges.
You will typically expect that the process when seeking medical care from a provider that is part of your network is the process is much smoother and streamlined, with less paperwork to complete and in some cases you may not have to make any payments upfront.
Providers are held to certain quality standards for plan members, this means that you can be certain you are receiving the highest possible quality of care when you seek in-network treatment, allowing you a certain peace of mind.
Your plan may not cover out of network care at all. If this is the case, you will have the pay the full cost of treatment yourself, and paying for health care without insurance can get very expensive very quickly.
If you seek health care from a provider outside of your network, you will certainly end up paying more for care, for a variety of reasons. If at all possible, try to make sure that any health care providers you use are within your insurance network. This will help keep your out-of-pocket expenses relatively low. For more information about insurance provider networks, please visit our insurance explained section to learn more.