Provider networks are an integral part of health insurance coverage. Basically, insurance companies contract with healthcare providers, creating a list of ‘in-network’ providers that you can utilize for your healthcare needs. Networks consist of primary care providers, specialists, pharmacies, hospitals and urgent care centers.
In-network benefits are the insurance coverage you receive when seeking care at one of these in-network providers. These providers are where you will receive the richest benefits from your health insurance…that means the lowest cost for you!
Out-of-network benefits are the insurance benefits you receive when seeking care at a provider that is not inside the insurance company’s network of providers. These providers are where you will receive less extensive benefits from your health insurance. On some health insurance plans, there is no coverage at all for care sought at an out-of-network provider, but we’ll talk more about different types of insurance plans in another video.
Any one insurance carrier may offer multiple networks, so when shopping for a plan you’ll want to be clear on which network corresponds to the health insurance plans that you’re comparing. The insurance carriers provide online ‘Find a Doctor’ tools that make it easy to see which providers and medical centers are in network on various plans.
A potential situation that worries people when it comes to in-network and out-of-network health insurance benefits is their ability to access healthcare when travelling, or in an emergency. Thanks to the Affordable Care Act, emergency care must be covered as if it were in-network, regardless of if the doctor or facility where you seek treatment is in the insurance carrier’s network.
Finally, networks can change from year to year. A provider or medical facility that was in-network this year is not guaranteed or required to contract with that insurance carrier in subsequent years. With this in mind, it’s important to check the network status of your providers from year to year.
