In-Network vs. Out-of-Network: What’s the Difference and Why Does it Matter?
Have you ever gotten an unexpected bill because the doctor you received health services from turned out to be an out-of-network provider? It is important to understand the differences between out-of-network vs in-network physicians to ensure you know how much you will pay out of pocket to receive care.
Read more to find out the key tips and tricks you need to know to avoid unexpected bills from out-of-network providers.
Key Takeaways
- Going to an in-network provider will result in lower out-of-pocket costs and help you avoid unexpected bills
- Out-of-network providers may request payment for fees higher than the health insurance carrier will pay, resulting in you having to pay the balance. This practice is also referred to as balance billing
- Always check your insurance carrier provider lookup tools to confirm if the doctor you are seeing is in or out-of-network
In-Network vs. Out-of-Network Providers
A group of doctors and healthcare providers contracted directly with your health insurance carrier is considered an in-network provider. The health insurance company negotiates contracts directly with in-network providers to help control health care costs and quality of care for their members.
An out-of-network provider is a doctor or health care provider that does not have a contract set up with your health insurance carrier. These providers are not limited to specific fees to charge the member for health care services received. This can expose members to unexpected bills and higher than anticipated service fees.
