Understanding Your Health Insurance Network Can Save You Money

Whether you’ve had the same health insurance company for years or you’ve recently switched to a new health insurance company, you may notice that the amount of money that you pay out of pocket varies from one healthcare provider to another. In most cases, this variance in cost is directly related to whether or not a healthcare provider is within your health insurance company’s network.

To get the most from your health insurance company, it’s important to be informed when you’re seeking out a new healthcare provider. To help control costs, your health insurance company has a list of in-network providers. However, accepting your health insurance and being “in-network” aren’t necessarily the same thing. By ensuring that you select a healthcare provider that is in your health insurance company’s network, you can save a significant amount of money.

Post - What Is a Health Insurance Network?

What Does It Mean to Be In-Network?

The cost of healthcare seems to go up every year, and individuals and health insurance companies alike strive to bring down the cost of care. To minimize the expense and ensure that they’re providing customers with competitive rates, health insurance companies negotiate with providers for lower rates on healthcare services.  In-network providers, which may also be called participating providers, are those who have contracted with your health insurance company to accept negotiated rates for the services that they provide.

Generally speaking, negotiated rates are lower, sometimes significantly lower, than the provider would otherwise charge for a given service to someone who did not have health insurance coverage.

To provide an incentive for receiving healthcare services at an in-network provider, health insurance companies may pay a greater portion of the cost of a service received. For that reason, you will typically pay less out of pocket when you go to an in-network provider.

If you have a PPO, POS or HMO health insurance plan, then your health insurance company likely has a list of in-network providers. Indemnity plans, also called fee-for-service plan, typically do not have in-network providers.

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What Does It Mean to Be Out of Network?

A hospital or other medical provider that has not contracted with your health insurance company to accept discounted rates is said to be out of network. Your health insurance company may cover a smaller percentage of the cost of the services you receive from an out-of-network provider, sometimes called “usual or customary” or they may pay nothing at all, leaving you to foot the entire bill.

It’s important to note that while a hospital or doctor’s office may accept your health insurance plan, especially if you’re a customer of a large insurer like BlueCross BlueShield or UnitedHealthcare, that doesn’t necessarily mean that they are an in-network provider. For that reason, it’s not enough to simply call up a doctor’s office to find out if they take your insurance plan. To ensure that you’re getting the best price for medical care, you should consult your health insurance company’s list of preferred providers, which can usually be easily found on their website.

While it seems like hospitals and medical practices would be strongly motivated to accept a health insurance company’s negotiated rates – after all, they’re almost guaranteed more business from that insurer’s customers – it’s not uncommon for providers to reject these lower rates. In most cases, this is a result of lower reimbursement (payment to doctors), meaning that the fees that are approved by the health insurance company are not enough to cover the cost of providing quality care, or not as much as the providers are needing/wanting.

Find a Health Insurance Plan with Nevada Insurance Enrollment

Choosing a healthcare provider can be a daunting task, especially if you or anyone in your family has health conditions to take into consideration. Fortunately, you don’t have to take on this task alone. A licensed health insurance agent at Nevada Insurance Enrollment can help you compare different health insurance plans, determine whether your preferred healthcare provider is in a health insurance company’s network or find a healthcare provider that is within your health insurance company’s network.

Whether you’ve recently moved to Las Vegas or Reno or anywhere in between, if you’re shopping around for health insurance or you need to find a health insurance plan that will allow you to keep your current primary care provider, the health insurance agents at Nevada Insurance Enrollment can help. Our health insurance agents specialize in helping Nevadans find health insurance plans that are the right fit for their health needs, budget, and lifestyle. Contact us today to begin the process of finding the best health insurance plan for you.

Related Articles:

Health Insurance: In Network or Out-of-Network?

How to get the most out of your Health Insurance plan

How to Choose the Right Health Insurance Plan

Individual and Family Health Insurance in Las Vegas, Nevada

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