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May 01, 2019

Healthcare 101: In-network vs. out-of-network

Health Insurance Networks

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Many things can put you in the market for a new doctor – finding a pediatrician for your children’s well-visits, a recommended follow-up with a specialist, or your first colonoscopy after turning 50. Whatever the reason, choosing the right doctor is important.

All health insurance plans have a network of doctors and selecting one who is in that network can save you money. In fact, some plan types require you to see an in-network provider. So, how do you find a provider who’s in your health plan’s network?

Recommendations from friends, family, and your PCP are a great place to start. If you have an Independence Blue Cross health plan, your next stop should be our Find a Doctor tool, which makes it easy to find in-network doctors and other health care providers, such as labs, hospitals, urgent care centers, and outpatient surgery centers. Review the questions and answers below to help you understand the difference between in-network and out-of-network and how to choose a doctor.

What is a provider?

A health care provider is a person or company that delivers a health care service to you. Types of providers include your primary care physician (PCP), specialists, and even facilities, like labs, hospitals, and urgent care centers.

What does in-network mean?

In-network refers to a health care provider that has a contract with your health insurance plan to provide health care services to its plan members at a pre-negotiated rate. Because of this relationship, you pay a lower cost-sharing when you receive services from an in-network doctor.

What does out-of-network mean?

Out-of-network refers to a health care provider who does not have a contract with your health insurance plan. If you use an out-of-network provider, health care services could cost more since the provider doesn’t have a pre-negotiated rate with your health plan. Or, depending on your health plan, the health care services may not be covered at all.

How do I know if a doctor is covered by my Independence Blue Cross health plan?

Use the Find a Doctor tool and start searching! Enter your location and health plan, and your search will return results that only include providers who are in your network.

Is it more expensive to see a provider outside of my health plan’s network?

Yes, typically you’ll pay more if you go to an out-of-network provider. Keep in mind that some health plans don’t have any coverage for non-emergency services received from an out-of-network provider. Be sure to check your benefits before picking a doctor or other health care provider.

What are the benefits of choosing providers in the Independence Blue Cross network?

With the Independence Blue Cross network, you have access to the largest network of doctors and hospitals in the region, with more than 49,000 doctors and 180 hospitals. In addition to paying lower out-of-pocket-costs, you also have the security of knowing we have screened the providers in our network to ensure they meet our quality standards.

Learn More:

• Review the basics of health insurance
• Read about the benefits of being an Independence Blue Cross member and being a part of the extensive Blue Cross Blue Shield network
• Shop and apply for a health plan

This content was originally published on IBX Insights.

About Paula Sunshine

As SVP and Chief Marketing Executive at Independence Blue Cross, Paula Sunshine is accountable for the Individual Under-65 market segment. In this capacity, she is directly responsible for developing and executing all direct-to-consumer marketing and sales capabilities. In addition, Ms. Sunshine is accountable for insuring the delivery of market-competitive products and pricing as well as operational readiness for the Consumer market.

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