IN-NETWORK vs OUT-OF-NETWORK CARE

In-network vs out-of-network care is a recurring theme, and we believe it is important enough to warrant it's own discussion here.

If you've ever reviewed your health insurance benefits, you've probably run across the terms in-network and out-of-network, but what does this mean exactly? Your health insurance carrier contracts with every type of healthcare provider including primary care physicians, specialists, and hospitals, and contracted providers all agree to be part of your carrier's provider network. Part of the contracting process involves your carrier and providers negotiating and agreeing to contracted reimbursement rates, and the agreed upon rates are just about always lower than what providers would charge on their own. In effect, network providers agree to offer discounted care to you and other members in return for participation in your carrier's provider network, which can help supply providers with a steady stream of patients. When a provider accepts your insurance carrier's terms and signs a contract agreeing to join your carrier's provider network, they become an in-network provider.

Now, for a variety of reasons, some healthcare providers do not contract with your carrier or with your particular plan type, such as an EPO; thus, these providers never join your health insurance plan's provider network. These providers are out-of-network providers. Because out-of-network providers have never signed a contract with your health insurance plan that obligates them to offer discounted fees, out-of-network providers can generally charge you whatever they wish for services rendered, and can many times hold you responsible for any and all costs not paid by your health insurance plan. Some plans offer out-of-network benefits and some do not.

The bottom line is that we always encourage you to seek in-network care whenever possible because it is almost always going to be more affordable. Whenever we discuss prices or costs of services on this site, we assume that we're comparing healthcare provider options that are all in-network with your particular health insurance plan. This allows us to compare apples to apples. Costs can vary greatly when you seek care outside of your plan's provider network. Many major health insurance carriers now have online tools that you can use to search for an in-network provider in your area, and if you're still unsure, call your health plan's member services number on the back of your health insurance card and ask for guidance.

Essential QSA Knowledge

In-network care is almost always going to be more affordable than out-of-network care, so seek out providers that are in-network with your particular health insurance plan whenever possible.

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