Let’s say you go for a routine doctor’s visit, have some testing done and then head home. A few weeks later, you receive an unexpected bill for hundreds of dollars. That’s right — those tests went from a responsible health move to a sudden financial burden the moment you went outside of your network.
If you’ve gone through this yourself, then you know how much of a difference health insurance networks can make. Not all insurance policies are created equal, and understanding the difference between your plan’s in- and out-of-network coverage could potentially save you hundreds (if not thousands) of dollars in health care bills.
What Are Health Insurance Networks?
A health insurance network is a list of providers — including doctors, specialists, hospitals, pharmacies, urgent care clinics and other medical professionals — your insurance company has an agreement with to provide health care at discounted rates to its members (meaning you). Any health care provider on this list is considered an in-network provider. Out-of-network providers, on the other hand, are those with whom your insurance company doesn’t have a contract.
You can find out which doctors or health care providers are in your plan’s network by logging into your insurance company’s online portal or by calling your insurance carrier. Typically, if you search for providers by specialty on your insurance company’s website, you’ll see a list of providers. If you’ve already done some research and have chosen a provider or are picking between a few of them, call your insurance company to make sure those providers are in your network.
Why is this important? Because going to an in-network provider will typically cost you less. Some health plans only provide coverage for in-network providers, while others will allow you to see an out-of-network provider — but many of them will only let you go outside of your network after you receive a referral from an in-network provider. In many cases, you may have to pay more out of pocket if you choose to go to an out-of-network provider.
How to Choose the Plan With the Right Network
Different health plans offer different levels of flexibility. Preferred provider organizations (PPOs), for example, allow plan members to see both in- and out-of-network providers. The difference is that you’ll pay less when you go to a provider your health plan has a contract with. Point of service (POS) plans also allow you to go to both in- and out-of-network providers, but you’ll need a referral to leave your network to find care. Other health plans, like health maintenance organizations (HMOs) and exclusive provider organizations (EPOs), limit you to in-network providers and only cover out-of-network providers for emergencies.
Special policies under the umbrella of supplemental insurance — like hospital indemnity, critical illness or accident plans — don’t usually have any network restrictions at all. Providing a cash payout for certain hospital stays, critical illnesses or injuries, these plans work just about anywhere you go to receive the care you need, with no added costs for going outside of your primary plan’s network.
Before you sign up for a policy, think about what you might need from it. Do you have a doctor you couldn’t bear to leave? Do you anticipate needing frequent specialist care? Would you feel better having a primary care physician who refers you to other providers, or can you handle that yourself? How’s your tolerance for out-of-pocket costs? Then be sure to compare the provider networks for the different plans you’re considering and understand the implications of each one.
Understanding your plan’s network can have a big impact on your health care costs. Spend a little time getting to know your network — and use that information to lower your chances of getting a big bill you weren’t expecting.