When you’re shopping for health insurance, it’s easy to focus on premiums and deductibles. But don’t overlook the provider network. This is a list of doctors, hospitals, and other health care pros that your plan works with. Checking if your current doctors are in the network can save you money and avoid surprise bills.
What Are In-Network and Out-of-Network Providers?
- In-Network Providers: These are doctors and facilities that have a contract with your insurance company. They agree to charge lower, set rates for services. You pay less out of pocket, like a fixed copay or a smaller share of the cost.
- Out-of-Network Providers: These do not have a contract with your insurance company. They can charge full price, which is often much higher. You might end up paying the difference between what they bill and what your plan covers (commonly called Surprise or Balance Billing).
For example, if a surgery costs $15,000, an in-network doctor might accept $10,000 from your plan with no extra bill to you. But an out-of-network one could make you pay the $5,000 gap.
Why It’s Important to Check the Network
Going out-of-network can raise your health care costs a lot. Your plan pays less, and you might face higher deductibles or coinsurance rates. Plus, those extra bills don’t count toward your yearly out-of-pocket limit.
If your doctor is not in the network for the plan you choose, you could pay more for routine visits or big procedures. This is extra important if you travel often or need specialists—make sure the network covers where you go.
How to Check If Your Providers Are In-Network
Before picking a plan:
- List your doctors and hospitals.
- Use the plan’s online provider directory to search for them to be sure they’re included in the plans you are considering.
- Check the plan’s Summary of Benefits for details on costs.
Take Action Now
Next time you’re shopping for insurance, check the network first. It could save you hundreds or thousands.
