Is my doctor covered? Here’s how to find out.
Avoid surprises by making sure your doctor, clinic or pharmacy is still covered by your insurance.
Have you ever gotten a bill from the doctor that was way more than you were expecting? You’re not alone. I field several calls a day from members going through this exact thing.
The most-likely culprit? The doctor you saw isn’t in your network, meaning they aren’t on the “list” of doctors that your health insurance will help pay for. I’m here to help you avoid this situation.
Yearly network changes
Health plans have contracts with doctors, clinics and pharmacies. Each year, health plans take a look at these contracts to make sure you receive the highest quality of care at an affordable price. To keep your costs lower, sometimes your network changes to include different places and people to get care from. Your favorite doctor or clinic might be in your network now, but be out-of-network next year.
Your health plan typically tells you about any network changes in the fall during open enrollment (when you’re selecting a plan for the next year). The network changes go into effect when your plan renews for the year, which usually happens on January 1.
Mid-year network changes
Doctors and clinics may join or leave your network throughout the year. If you haven’t gotten care from that doctor or clinic in a while, your health plan or your doctor might not notify you of this change. Or sometimes your in-network doctor may refer you to a specialist that isn’t in your network.
In these situations it’s good to check and make sure your doctor, or the specialist your doctor is recommending, is in network before you schedule your appointment.
Is my doctor in-network? Here’s how to find out:
- Visit your health plan’s website to find an updated list of doctors, pharmacies and clinics in your network.
HealthPartners members: Check your network by logging into your online account here!
- Call your health plan’s Member Services department. They’ll help you understand your specific plan details and point you to a doctor, clinic or pharmacy that’s in-network. Your Member Services phone number is typically listed on your insurance card.
- Don’t rely solely on your doctor’s office. Your doctor’s office may say they “accept” your insurance, but that doesn’t mean they accept your specific plan. It all depends on the specific plan you signed up for. That plan will have a very specific network. Always check with your insurance company if you have questions.
What if my doctor is no longer in-network? You still have options:
- Are lower monthly costs important? You can keep your health care costs lower by switching to a doctor that’s in your plan's network.
- Do you like your current doctor and don't want to change? If so, that’s okay. You will pay more for each visit, or may need to change carriers, since your doctor is out of your network. When it’s time to select your new insurance plan again in the fall, you can compare plans to see if it makes sense to switch to another plan or insurance provider that includes this doctor.
Related content: 3 signs it’s time to switch your health plan
Before you schedule an appointment with your doctor, check to see if he or she is included in your network. That way, you can avoid those surprise bills.
About Barb Breher
Barb Breher is a leader in the Member Services department at HealthPartners. She specializes in individual and family health plans. Barb loves helping members understand and use their coverage (it’s confusing!). When she’s not working, she loves relaxing and camping with her husband and two young daughters. Minnesota locals: she highly recommends Voyageurs National Park.