Do you know what a health plan network is? Or why it's important to your insurance coverage? A network is a group of doctors, hospitals and other health care providers. This group has worked with us to get special deals just for you. When a health care provider is in your network, it's called "in network."
When you use in-network providers, your health insurance covers more of the bill. If you choose a provider outside of your network (also called nonpreferred or non-network provider), your insurance pays less or sometimes nothing (depending on your plan). So, you pay more out of your own pocket.
But did you know that networks go beyond doctors and hospitals? As your health plan, we negotiate discounts on many kinds of health care services, including:
- Medical imaging such as MRI, CT and X-ray
- Laboratories that process bloodwork
- Medical equipment such as wheelchairs, oxygen, insulin pumps, and wound care supplies
Prescription drugs and pharmacies
Here's why you should make sure that your medical care is in-network. Your doctor might have a certain lab she uses or a medical imaging facility that she recommends to you. But your doctor probably doesn't know which facilities are in your network, so she might refer you to one that's not in your network, which could cost you more money. That's why it's important that you ask, or contact us to find out.
If you're planning a procedure such as surgery or MRI, you can learn more about your expected cost by using Treatment Cost Estimator. You can also compare prices between providers and see which are in your network.
If you're not sure what network you're in, call the number on your member card and a Customer Service representative will be happy to help. You can even get a guided tour of the Treatment Cost Estimator tool.
We want to help you get the most for your money. If you need help understanding your network, finding an in-network provider or finding the best prices, just contact us. We're here to help.
Note: Make sure all your care is provided by in-network providers. If you receive care from an out-of-network provider, even if you are in an in-network facility and/or other providers treating you are in-network, you may have additional costs. Except as prohibited by law, these additional costs may include higher cost-sharing (such as any applicable out-of-network deductibles, coinsurance, copays, or out-of-pocket maximums), as well as responsibility for balance billing (that is, for the difference between the out-of-network provider's charge and our allowed amount). Also, the additional costs may not count toward any in-network out-of-pocket maximum in your plan. Review your policy or benefit booklet for details about coverage of out-of-network care.
Watch this short video to learn what to do if you are referred to an out-of-network provider.