You have sure­ly heard the terms “in-net­work” and “out-of-net­work” when refer­ring to doc­tors or care facil­i­ties and your insur­ance plan. It can be con­fus­ing and make you won­der why it mat­ters to you, as the con­sumer. Let’s explore these terms and find out more!

What are Health Insur­ance Plan Networks?

Health insur­ance plans cre­ate net­works of doc­tors and facil­i­ties with which they have con­tract­ed to accept nego­ti­at­ed rates for the ser­vices they pro­vide.  When you sub­scribe to a spe­cif­ic insur­ance plan, you can look up the list of these con­tract­ed providers to see which ones are “in-net­work.” Most plans have help­ful search tools online like “Find a Doc­tor” to save you time as you look for your spe­cif­ic doc­tor. You can also call the facil­i­ty or health­care provider and ask if they are con­sid­ered “in-net­work” or “out-of-net­work” for your par­tic­u­lar health insur­ance plan.

Why Choose “In-net­work” Providers?

When you make the choice to see an “in-net­work” health­care provider or vis­it an “in-net­work” facil­i­ty, you will typ­i­cal­ly pay less for the ser­vice (doc­tor vis­it, screen­ing, hos­pi­tal stay, etc.) than if you chose to use a provider out­side of the plan’s net­work. Your insur­ance plan has nego­ti­at­ed a dis­count­ed cost for the ser­vice and pass­es that sav­ings on to you, the sub­scriber. See the table below for an example.

Addi­tion­al Ben­e­fit to “In-Net­work” Care

Some health insur­ance plans allow you to vis­it “out-of-net­work” doc­tors and facil­i­ties with the under­stand­ing that you will pay more for these ser­vices since they are not in an agree­ment with one anoth­er. How­ev­er, you may not be able to apply these expens­es towards your annu­al deductible.  This means it may take you longer in the year, with more out-of-pock­et expens­es, to reach your deductible. Stay­ing “in-net­work” alle­vi­ates this delay and any added costs.

Stay­ing with “in-net­work” providers tru­ly equals greater cost-sav­ings to the con­sumer. By doing a lit­tle research upfront to find the doc­tors and facil­i­ties in your plan net­work, you will end up with less out-of-pock­et expens­es for your health care each year. While the choice is ulti­mate­ly up to you on who you see for your care, look­ing with­in your plan net­work will reap you great benefits.