Find an In-Network Provider: 5 Tips To Get Care And Save Money

Looking for a health care provider? There’s something you need to do before you book a doctor’s appointment or go to the hospital: make sure your providers are “in-network.”

You could save money with an in-network provider

If you get care from an out-of-network provider, you may be surprised by your medical bill. Some health plans only pay for a part of out-of-network care, and some provide no coverage out-of-network. You may also pay out-of-network fees, too. That could leave you with medical bills that cost a lot more than your copay.

In a recent analysis of trends in medical billing, researchers found that:¹ 

• 1 in 5 adults get a medical bill that’s a lot more expensive than expected.
• 67% of adults aren’t sure how they would pay for higher-than expected medical bills.
• The most common source of high-medical bills are out-of-network charges.

Making sure you get care from an in-network provider could save you money, and it can help prevent any surprise medical expenses.

What’s the big difference between in-network providers vs. out-of-network providers?

Insurance companies create networks. Insurance companies ask providers if they will charge agreed upon rates for specific services. If the providers agree to these rates, they are part of the network and can be called an “in-network provider.” If the providers do not agree to join the network, the health insurance company will label them “out-of-network.”

Now, here’s where it gets a little complicated.

An in-network hospital or medical office can still work with out-of-network providers. This means that while you may have confirmed the facility you are going to will be fully covered, you could still be using an out-of-network provider’s services. Even if a doctor’s office or hospital contracts out-of-network, contact your planned care facility to make sure you’re using in-network providers.

If you have additional questions about how in-network facilities can still have out-of-network providers, feel free to contact your insurance plan. A plan representative can give you additional information that may help. You can also contact a licensed health insurance agent with coverage-related questions.

How do you find an in-network provider?

Looking for an in-network provider to get the care you need? Verify before you go. There are five things you can do to make sure your next appointment or visit is with an in-network provider.

1. Check your insurance company’s website.

Many insurance companies will post in-network providers for the plans they offer. But, these web pages aren’t always updated. If you do use this feature, make sure you are comparing networks for your specific policy and not just for the company.

2. Check your provider’s website.

Health care provider websites (like hospitals and doctor’s offices) may also list the networks they are part of. But, they may also be outdated and may not list which network each doctor participates in.

3. Call your provider.

If you are visiting the doctor or planning an operation, call the facility before you go. You can ask the office to verify that all of the providers you will be seeing are part of your plan’s network.

4. Call your insurance company.

You can also call your insurance company to verify in-network providers. Before you call, make sure you have your policy number and plan information. This call will help your insurance company verify approved in-network providers.

5. Call your agent.

It might seem inconvenient or time consuming to find an in-network provider. But it can save you a lot of money related to medical care costs. If you need to find a new plan that includes the provider you need, a licensed health insurance agent can help.

Find a health plan and in-network providers

Using in-network providers is only a small part of saving money on your medical expenses. Learn more about health insurance and how you can save money by visiting HealthMarkets’ resource center. Or, speak to an agent today at (800) 827-9990.