06 Sep In or Out?
One question we often hear from our clients is, “What’s the difference between in-network and out-of-network when choosing my doctor or hospital?”
In-network doctors and hospitals have contracted with your insurance carrier to accept certain discounted rates. You will always pay less with an in-network provider. An out-of-network doctor or facility has no contract with your health plan and they can charge you full price for their services. This means you could pay thousands more for services outside of your network. Most carriers do have a few exceptions and will cover you if you are out-of-network. These may include;
-if you are traveling out of network and need medical care (not internationally),
-if you cannot get the treatment you need in your network you may be able to obtain approval from the provider to go to a doctor or facility out-of-network.
It’s usually up to you to determine whether a doctor, medical group, or medical facility is in-network for your insurance plan. To do this you can go to your insurance carriers’ website or call the customer service number on the back of your insurance card. Just asking the physician or hospital to see if they accept Blue Cross, United Healthcare, or Aetna for example, does not mean that they are an in-network provider for your specific plan. You will need to provide your specific plan information when calling.
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Material posted on this website is for informational purposes only and does not constitute a legal opinion or medical advice. Contact your medical professional or legal representative for information specific to your needs