What Does It Mean to Be In-Network?

The cost of healthcare seems to go up every year. Individuals and health insurance companies 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, also known as participating providers, are those who have contracted with your health insurance company to accept negotiated rates for the services that they provide.

Negotiated rates are lower than the provider would charge for a given service to someone who did not have health insurance coverage.

To provide an incentive for receiving healthcare services with 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. Again, if your plan is an HMO or EPO, you are required to stay in the network, and they will not offer any out of network benefits.

If you have a PPO, POS, or HMO health insurance plan, then your health insurance company will have a list of in-network providers.

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 small percentage of the cost for services you receive from an out-of-network provider but usually won’t cover it at all. Sometimes the insurance company will pay what’s called “usual or customary” and if not, you will be responsible for 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. 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 is usually found on their website. Now and days, if you create an account online through your health insurance providers website, your individualized portal will have the doctors and providers you can go to.

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 have 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 Nevada, 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 individuals 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

Read More: Health Insurance in Las Vegas, Nevada

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