In-Network & Out-of-Network

In-Network

Health insurance companies contract with provider groups, doctors, care specialists, hospitals, and other health care providers in a network to receive a special rate for their services. They are then considered “in-network.”

Out-of-Network

Health insurance companies that do not contract with provider groups, doctors, care specialists, hospitals, and other health care providers in a network to receive a special rate for their services are considered “out-of-network.”  There is no discount applied to the service you received from that provider. Health insurance companies try to discourage members from going to out-of-network by charging them higher co-pays, co-insurance, and deductibles.

For example, in the table below you can see both scenarios for a visit to the same provider with the same bill from the doctor. But because no discount is applied and the co-insurance is higher the plan ends up paying less and you end up paying more.

 
In-Network
Out-of-Network
Doctor’s Bill
$500
$500
Discount Applied
20%
0%
Amount to Pay
$400
$500
Co-Insurance
20%
50%
Plan Pays
$320
$250
You Pay
$80
$250

In-Network Providers

Have In-Network Providers negotiated for special rates with your insurance carrier?

Yes!

Read More

Out-of-Network Providers

Are discounts applied to your services from an Out-of-Network Provider?

Money Savings

So which would you pick and why?

Yes, it all depends!

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