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In-Network Providers? What is that?

By September 15, 2015 No Comments

formsKnow Before You Go

You’ve probably seen the terms “in-network” and “out-of-network” on your insurer’s website and in your plan description.  But, what do these terms mean? And how do they affect how much you have to pay for your care?

Your plan contracts with a wide range of doctors, as well as specialists, hospitals, labs, radiology facilities and pharmacies. These are the providers in your “network.” Each of these providers has agreed to accept your plan’s contracted rate as payment in full for services.

That contracted rate includes both your insurer’s share of the cost, and your share. Your share may be in the form of a co-payment, deductible or co-insurance (more information on cost-sharing is available here). For instance, your insurer’s contracted rate for a primary care visit might be $120.  If you have a $20 co-payment for primary care visits, you will pay $20 when you see a doctor in your network.  Your insurer will pick up the remaining $100.

If you go outside your network, it’s a different story. You will likely pay more if you go “out-of-network” for your care. That’s because:

  • Providers outside your network have not agreed to any set rate with your insurer, and may charge more.
  • Your plan may require higher co-pays, deductibles and co-insurance for out-of-network care. So, if you normally have to pay 20% of the cost of the service in-network, you may have to pay 30% out-of-network. Often, you’ll have to pay that PLUS any difference between your insurer’s allowed amount and what the provider charges.
  • Your plan may not cover out-of-network care at all, leaving you to pay the full cost yourself.

 

http://fairhealthconsumer.org/reimbursementseries.php?id=15

 

ABW Massage In Network Providers for Regence, HMA, Uniform Medical health plans

 

ABW Massage In-Network Providers for all other Insurance Companies.  Call your insurance carrier for information on who in your network.  The number is located on the back of your insurance card.

Call 360-366-4216 to schedule appointment with A Better Way Massage & Acupuncture today.

Shannon Freeman

Author Shannon Freeman

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