Health Insurance Basics: In-Network vs. Out-of-Network

Among of the terms that you will run into when you deal with health insurance are “in-network” and “out-of-network.” These terms are generally used to describe health care providers. Understanding these terms is important if you want to know what is covered by your health insurance company.

In-Network vs. Out-of-Network

Not all health care providers accept all insurance plans. This means that your health insurance won’t be accepted everywhere. An in-network provider is one that is part of the health insurer’s network, and that is interested in accepting the insurance.

On the other hand, if the provider is out-of-network, it might be harder to get coverage. This is because, in general, the provider doesn’t accept the insurance that you carry. You might have to pay the entire amount of the visit out of the pocket and then ask the insurance company for reimbursement later.

Most insurers are willing to pay a portion of your costs, even when you go to out-of-network providers. However, if you stay in-network, you might only have to make a co-pay of $25 or $30 for an office visit, and only 20% of the cost for other types of health care. This is much less expensive overall. If you choose an out-of-network provider, though, you might end up paying 50% of the total cost — and you’ll have to apply for reimbursement from your insurer. In some cases, an insurer might not pay any of the cost of an out-of-network provider.

Choosing In-Network Providers

One way to handle this issue, and to make sure that you get the health insurance coverage you want, is to make sure that any you double-check that health care providers you choose are considered in-network. Before you begin seeing a doctor or specialist, find out if they are in-network. You can also research the hospitals in your area to see which facilities are part of your insurer’s network. When you have the choice, you will know where you need to be taken for in-network care.

The other option is to choose an insurance company that covers your preferred health care providers. If you like your current health care providers, find out what insurance company they all have in common. You can then get coverage from a company that works with your preferred service providers.

If you travel frequently, it’s a good idea to find out if your health insurance covers facilities in the areas you visit. I know which health care providers are in-network near my parents’ home, as well as those that are available near my in-laws’. This is helpful, since I can get the health care needed while visiting family members. When I travel elsewhere, I am also careful to check to see what in-network providers are nearby.

It’s especially important to check your options if you plan to travel overseas. Find out from your health insurance company what is covered. You might need to purchase additional insurance if you want to be adequately covered when you travel outside the county. Indeed, a good rule is to check with your insurer to verify your health care options whenever you are unsure.

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