In-network vs out-of-network

One of the core ways of keeping your costs of healthcare at the lowest rate possible is to use only in-network providers and facilities.

Most people believe that a call to the facility or the provider is the fastest and most reliable way of confirming that information. Unfortunately, because there are so many insurance companies, each of which can offer tens of different policies, it is becoming extremely difficult for a healthcare provider to guarantee in advance of submitting a claim for payment, being in your network.

How to find doctors in network

Provider networks are created and managed by the insurance company. Most of them actually select the doctors and facilities for each network rather than have the providers request to participate in those networks. This is particularly true for networks associated with high deductible plans and those on the federal and state Exchanges. While a physician or facility can request to be removed from participating in an insurance company’s networks, they often cannot request to become a participating provider.

Health insurance provider networks

The only way to absolutely guarantee if a provider is in network with your plan is to call the plan and ask them. The customer service rep will have access to your exact plan and will be able to tell you if a specific provider is in your network. For a plan that requires that you select a primary care physician, the sure-fire way to determine network coverage is to ask to have your doctor listed as your primary care doctor. If that can’t be done, that doctor is definitely not in your network.

So before you become frustrated by what appears to be a run-around by your doctor’s office, call your insurance company. The buck stops with them.



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