It helps when you understand the ins and outs of your health care benefits, especially when you’re in search of a doctor or health care facility. But if you’re wondering why to visit doctors in your provider network, you may question how much it actually matters. And what if you’re not sure how to find one?
What is an in-network provider?
An in-network provider belongs to a group of hospitals, doctors, nurses and other health care providers your health plan has contracted with. These providers have agreed to discounted rates for the services they offer. When you stay in your network, this usually means a lower deductible, less coinsurance and fewer out-of-pocket expenses for you. You are always free to visit any health care provider you want, but you’ll typically receive the best rates when you choose participating (in-network) providers.
How do I find out what doctors are in my network?
We know it can seem hard to figure out what provider is in-network, so we’ve put together a couple options to help you locate some.
- Call your health care benefits company. You can call your insurance or health care benefits company at the number on your ID card. Your plan may also offer an online tool to help you search for in-network providers by specialty and condition needs.
- Look at your doctor’s website. Sometimes your doctor, hospital or specialist will list which insurances/health plans they accept right on their website.
- Call the doctor’s office. If you don’t see your insurance/health plan listed on their website, you can also call the office and speak to a staff member. They can help you find out if the provider you want to see is in your network. Have your ID card ready in case they need any information from it, like the name of your provider network.
- Check your member handbook. It’s a useful tool, filled with helpful information about your plan. Check to see if your handbook lists any in-network providers.
What to expect during your visit
When you visit the doctor, you may already be a little on edge—without needing to worry about how your care will be covered! So, when you visit an in-network provider, it can help ease your mind a bit. In most cases, the provider’s office will make a copy of your ID card for your file so they know in advance how to bill you for the service you receive.
However, if you visit an out-of-network provider, it’s a little more tricky. You may not have the same coverage and discounts because out-of-network doctors have not agreed to contracted rates. This means you could end up having to pay a lot more for your care. When you visit an out-of-network provider, it’s common to pay up front and then file a claim for reimbursement according to your out-of-network benefits (if this is part of your plan coverage). An exception could be emergency care, when you might receive coverage at the in-network rate.
Still unsure about network providers?
If you’re still not sure which providers are in your network, don’t worry! You can learn more by contacting the Customer Service department of your benefits plan. You can also check out our informational video about the advantages of using in-network providers.
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Have other questions about your health care benefits? The Meritain Health YouTube channel includes lots of videos with more information about topics our members frequently ask about, and much more!