Most people are aware that their health insurance plans only cover certain providers. But figuring out which providers are in your network isn’t always easy. So why is staying in-network worth it? And how do you find someone in your network?
The short answer is that by using in-network providers, you can get higher quality care for a lower cost. And if you know where to look and who to ask, you can figure out which doctors are in your health plan’s network without much hassle.
What’s the difference between in-network and out-of-network coverage?
Insurance companies want their members to get the best possible care at the best possible price. Most insurance companies, including HealthPartners, review patient surveys, claims information and overall health care data to carefully select doctors, nurses and other clinicians for their members’ care.
Insurance companies make special price arrangements with these selected providers, who agree to be on a unique provider list. That list is part of your insurance plan, called a network. When you visit in-network providers, you receive services at a discounted price.
Most often, insurance plans cover more of the cost when you see in-network providers. So your copay, coinsurance or deductible – the amount you’re responsible for paying when you get care – is usually lower. Those are additional savings you get on top of the reduced cost offered by in-network providers.
Higher quality also means lower costs. When you get care from a high-quality provider, you need less follow-up care, keeping more money in your wallet.
Going in-network for preventive care services
When it comes to preventive care services, it’s especially important to see an in-network doctor. This is because preventive health care is usually covered 100% – but only when you receive care from a doctor or clinic your plan covers.
What’s considered preventive care? It's what you do to keep yourself healthy, such as your yearly exam, immunizations and health screenings.
What happens if I go out of network for care?
First and foremost, if you get care outside of your network, then you won’t receive the discounted rates that you get as part of your plan. And the parts of your plan that help control your costs, such as coinsurance, copays and deductibles, may not work the same.
Does insurance cover out-of-network care?
Certain types of plans don’t cover any of the costs associated with an out-of-network visit. Other plans may cover part of the visit, but you may be responsible for paying a larger portion of the cost than if the visit were in network.
It’s also important to note that a provider’s office may accept your insurance carrier, but that doesn’t necessarily mean that the individual has an agreement with your specific plan. Ask your provider or call your insurance carrier if you’re unsure.
One more important thing to note: You’ll always be covered for emergency care in the United States at your plan’s in-network rates, no matter where you get care. For follow up care after an emergency, use in-network providers for the best coverage.
How do I find a doctor who’s in my network and takes my insurance?
These are your best options for how to check if your doctor is in-network:
- Go to your insurance company’s website to get an updated network list. If you’re a HealthPartners member, the easiest way to search your network is through your online account. You can also sign in to myHP for iOS or myHP for Android to search for covered doctors.
- Call your insurance company. Reach out to your plan’s member services team to get help with any questions about using your plan – you can usually find their phone number on your health insurance member ID card. If you’re a HealthPartners member, you can see personalized contact options online, or you can also call the number on the back of your member ID card.
- Ask your care provider. Based on your health insurance carrier and plan name, your provider will be able to tell you if they take your insurance.
Keep an eye on the list – provider networks can change
Insurance companies routinely review their networks – providers may be added or removed from the list. At HealthPartners, changes are made to make sure the network remains low cost and high quality. Before you schedule an appointment, check to see if your doctor is in your network so you have a good sense of what to expect.
What if I want to get a cost estimate for my health care?
Even if different providers are all in network, they’re allowed to charge different rates for the same services or the same prescription drug. Those rates can also be influenced by where you get care, like in a doctor’s office versus a hospital.
Fortunately, your insurance carrier might have price transparency tools that can help you estimate what you’ll pay out of pocket, whether you get in-network care or out-of-network care. Check with your plan to see what your options and resources are.
Many HealthPartners members can sign in to access our cost estimate tools online – these tools take into account your specific coverage, which can help you find the care you’re looking for at a price that’s right for you.