In-Network vs. Out-of-Network Doctors
In-Network vs. Out-of-Network Doctors
by sch43yt9824huilb

How Will In-Network vs. Out-of-Network Affect Me?

One of the first questions you may have when introduced to health insurance policies is the difference between a policy’s in-network vs. out-of-network coverage. Most health insurance policies will present different costs for each type of coverage. But what do these terms mean, and how do they affect your pocketbook?

What is an In-Network Doctor?

In-network doctors are those with whom your insurance company has agreed to partner. The doctor accepts your insurance, and your insurance company acknowledges your doctor as a contracted healthcare provider. For that reason, these two parties have agreed to set costs for the doctor’s healthcare services. The insurance company and the doctor both know ahead of time what a service will cost. As a result of this certainty, the insurance company can take on a larger portion of the expense and the savings are passed along to you, the individual policyholder.

It’s wisest to stay in-network anytime you need to visit a doctor or a specialist. You can verify if a doctor is in-network by going to your insurance carrier’s website and searching the doctor by name. If their name is listed on the site as an in-network doctor, you know you’re good to go. You can also call the doctor’s office directly to ask if the doctor is in your carrier’s network.

However (and this is important): just because a doctor or specialist accepts your insurance, it doesn’t mean they are in-network. An out-of-network doctor can still accept your insurance, but they won’t be able to pass along the discount. Always clarify!

What is an Out-of-Network Doctor?

Out-of-network doctors don’t have a partnership with your insurance company. They do not have a standing contract with your insurance provider to negotiate standard costs for services. For this reason, visiting an out-of-network doctor can be more expensive, because the insurance company hasn’t approved the doctor’s cost for service. In this case, the difference between what the doctor charges and what the insurance company will cover gets passed on to you, the patient. This is what’s known as “balance billing”.

How to Stay Savvy

Before you schedule any appointments or accept any treatment, always do your homework. The overwhelming majority of the time, you will save money by being treated by someone in-network, so again, determine beforehand. If you’re being treated in a hospital for more involved care, don’t be afraid to ask each time you see a new doctor whether they’re in your network. Doctors have been known to involve out-of-network colleagues in a patient’s care without discussing the fact that they are out-of-network, resulting in the patient taking on the costly expense of that additional doctor’s balance billing.

Keep in mind that the principles for choosing in-network vs. out-of-network doctors can also apply to dental care and vision care.

When it comes to your health insurance coverage, never be afraid to ask questions. The question you almost didn’t ask could be the reason you save hundreds (or even thousands) of dollars! Have additional questions? Reach out to the insurance experts at Schechner Lifson Corporation today.