Did you know that roughly 90% of individuals have either private or public health insurance? Sadly, just because you have health insurance doesn’t guarantee that you’ll be able to have access to the physician or provider that you want.
If your insurance isn’t in-network, then you could end up paying for the entire medical bill out-of-pocket. So, how do you find out if your insurance is in-network? Simple: by reading this article.
In it, we’ll walk you through everything that you need to know about in-network and out-of-network contracted providers. That way, you don’t end up spending a fortune on the care that you need. Let’s get started!
How Does Your In-Network Insurance Differ From Your Out-of-Network Insurance?
Before we begin it’s important for you to first understand the difference between in-network and out-of-network providers. The biggest difference is that out-of-network providers will typically cost you a lot more than in-network providers.
Why is this? It’s because your insurance provider makes contracts with various doctors, facilities, pharmacies, and other healthcare professionals. So, the term “in-network” refers to these providers that have a contract with your insurance provider.
These providers have negotiated a rate with your insurance provider for their services. Typically, this rate comes at a discount. In return, the healthcare provider or facility receives an increased number of visits.
So, if a provider is out-of-network, then that means that they haven’t negotiated a contract with your provider. This means that you are charged the full price for their services.
When you make payments to these out-of-network providers, your insurance plan will likely not apply them to your deductibles or out-of-pocket maximums.
Difference Between HMO vs PPO
It’s important to briefly understand the difference between an HMO and a PPO plan. HMO stands for health maintenance organization while PPO stands for the primary care provider.
The difference is that with an HMO you must choose doctors that are in your network if you want your service to be covered. Meanwhile, with a PPO, you can see doctors that are outside of your network. However, you will likely end up paying more for these providers.
Finding Out Which Doctors Are In-Network Isn’t Always Easy
Sadly, finding a healthcare provider that’s in your network can be quite difficult. Why is this? Because just because a provider accepts your insurance plan doesn’t mean that they always consider in-network.
The reality is that insurance companies will typically offer their plans at a variety of price points. This means that the different policies offered by providers like Aetna can contain minor subtleties.
For example, if your policy comes with low premiums, then it usually sacrifices selection. As such, you’ll have a much smaller pool of providers to choose from. To make matters even more confusing, networks often change at a moment’s notice. As such, a doctor that’s in-network for you one day, might not be the next day.
This also makes it challenging because network databases aren’t always up-to-date. This means that some doctors that are included in your plan might not show up. It also means that some doctors who are listed aren’t in-network. Talk about a headache!
Make Sure That You Verify Everything
So, we’ve seen what a nightmare it is finding a doctor that is in-network for you. So, what’s the solution? Simple: you need to verify everything. You can start doing this by calling a healthcare provider’s office and asking whether they are in-network.
You can also use your provider’s look-up tool. Most providers offer this as a way to find doctors that are specifically in-network for you. However, as we went over, it’s important to remember that networks are constantly changing and updating.
As such, we recommend calling the doctor’s office and getting a tax identification number. Once you’ve got this, you can call your insurance provider and give them the tax identification number. From there, they should be able to give you information about whether you’re covered by them.
Also, make sure to ask specifically whether or not they’re in your network. There’s a big difference between this and a doctor that’s simply covered by your insurance provider.
It’s also a good idea to ask for the verification to be sent to you in writing. That way, you have physical proof for legal purposes if they should arise.
How to Find a New Physician or Healthcare Provider
Some people would rather pay higher costs than give up a physician or healthcare provider that they’re comfortable with. Unfortunately, many people don’t have the luxury to do so.
If you fall in this category, then it’s important to find a new provider that is in your network and provides a similar level of care and attention. So, how do you do this? One way you can start is by asking for recommendations.
If you’re pleased with your provider, but can’t afford them, then ask them for some good referrals. Or talk to friends, family, or acquaintances for suggestions.
We also recommend resources like Fifth Avenue Healthcare Services. This credentialing service helps make sure that you find a provider that’s in your network.
However, more importantly, they ensure that the healthcare professionals meet their standards for care and professionalism. As such, it’s a great service for finding and verifying healthcare professionals.
Want More Content? Keep Reading
Do we hope this article helped you answer the question, Is my insurance in-network? As you can see, there are a lot of factors that can determine your list of in-network providers. As such, it’s important to call and verify everything.
Not only whether they accept your insurance provider, but also the agreed rate and the co-pay amount. That way, you know for sure what you’re getting into in terms of how much you’re paying.
Did you enjoy this article? If the answer is yes, then you’re in the right place. Keep exploring to find more topics that you’re sure to love.