Understanding the Difference between In-Network and Out of Network

Between deductibles, limits, maximums and co-insurance percentages, it can be pretty challenging to understand all the ins and outs of your health insurance policy. But in order to utilize the policy properly and make health care decisions that your policy affords you coverage for, you need to take the time to understand all of these terms. By far, one of the most confusing concepts is that of in-network and out-of-network providers, but it’s also one of the most important when it comes to choosing health care providers.

In-Network Providers

Your insurance company has worked with a group of medical treatment providers and facilities to deliver treatment to insurance policyholders at a pre-negotiated price. When you see one of these individuals or go to one of these centers, it is considered to be an in-network visit. This entitles you to in-network coverage which will have a lower co-insurance cost and lower overall service price than an out-of-network visit.

If you do not already have a regular doctor that you see, then working within your insurance company’s network should be no problem. But if you already have a set of doctors and specialists that you have established a relationship with, you may want to check with a potential insurer to make sure these doctors will be considered in-network before you take out a new policy.

Out-of-Network Providers

If you see a practitioner or go to a facility that is outside of this network and that hasn’t agreed to offer services at the insurance company’s discounted rate, then you are going to an out-of-network facility

In some insurance policies, you might have no coverage at all if you see an out-of-network provider unless it’s an emergency and there was no in-network option available. Some policies allow for a reduced co-insurance payment if you see an out-of-network provider.

By creating a network of providers, your insurance company is better able to control costs and premiums. When you visit a medical practitioner out of their controlled network, they must limit the amount of coverage they can afford you for the visit because otherwise, their insurance costs would be less controlled and could skyrocket out of control, making affordable premiums a thing of the past.

Find out more about your Round Rock Health Insurance options from Evans, Ewan & Brady today!

Posted 11:12 am