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 does in-network mean for insurance? How does it lower your costs?
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 info 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.
In-network vs. out-of-network insurance
So what happens if you get care outside of your network? First and foremost, 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 – or at all.
Certain types of plans don’t cover any of the costs associated with an out-of-network visit. Other plans may still cover part of the visit cost, but then you may be responsible for paying a larger portion of the remainder.
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.
How do I find a doctor who is in my network and takes my insurance?
These are your best options for how to check if your doctor is in-network:
- Sign in to your insurance company website for an updated network list. HealthPartners members can sign in online or with myHP for iOS and Android to search for covered doctors.
- Call your insurance company using the member services line, which you can usually find on your insurance card. HealthPartners members can also find contact information online.
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 to avoid surprise bills.