How to check if a doctor is in your network

Three doctors walk down a health care clinic hallway and talk with each other while referring to information on a tablet computer one of them is holding

Health insurance carriers seek out trusted, high-quality health care providers, negotiating with them to care for their members at a discount. This group of providers (doctors, clinics, hospitals, labs, pharmacies and more) that apply to your health insurance plan is called your network. Carriers encourage their members to see in-network providers because everyone wins: Patients pay less for quality care, doctors see more patients and insurers have more predictable expenses.

If you see out-of-network providers, you may end up paying more because your plan won’t help pay for as much of the cost (or sometimes won’t help at all). Plus, some amounts you pay to see an out-of-network provider may not count toward your plan’s deductible and out-of-pocket maximum.

Below, we’ll review how to make sure the doctors and specialists you see are in your plan’s network. We’ll also share other good-to-know tips to help you navigate your network confidently.

Ways to know if your provider is in network

There are several ways to see a list of the in-network care providers in your area:

Nearly all health insurers provide their care provider network list online. For example, if you’re a HealthPartners member, you can sign in to your account to find in-network providers or use the HealthPartners mobile app for iOS or Android.

You can also contact your health insurer directly for network information. Often, you’ll find your plan’s Member Services number on the back of your health insurance member ID card.

Another option is to ask your health care provider directly. However, it’s important to ask not just if your provider accepts your health insurance carrier, but specifically if they’re in your plan’s network. Your provider can look at your health insurance member ID card to check.

Being specific is important because health insurance carriers usually have multiple networks, and some providers aren’t included in all of them. So it’s a good idea both to confirm your provider is in network for your specific plan and to follow up with your insurer to confirm.

A doctor takes a break outside a health care clinic on a sunny day while looking at something in the distance

Health care provider networks can change

Your insurer is constantly looking at all its networks to help make sure you can continue accessing high-quality care at a lower cost. That means your network may gain or lose providers from time to time, whether due to clinics opening or closing, doctors moving their practices between clinics, or other factors. It also means different plans within your insurance company probably use different networks, depending on the care each plan is designed to support.

So it’s important to regularly double check your plan’s network to make sure the providers you want to see are still on the list. The best times to double check your plan’s network are:

  • When you’re considering a health care provider or location you haven’t seen before with your current insurance plan
  • When you re-enroll in your plan each year
  • When you’re shopping for a new plan, either with the same health insurer or a different one
Sitting in a clinic waiting room, a young mother smiles at the phone in her hand while her smiling young daughter sits on her lap.

You can often get cost estimates for in-network care

Have you ever wanted to know how much your health care will cost before you get it? Providers often have different pricing agreements with your insurer, even if they’re all in your plan’s network. In the past, that made it tricky to know your cost up front.

Fortunately, health insurers today have cost estimator tools that can help many members estimate what they’ll pay out of pocket at in-network providers. Cost estimators calculate price information according to your specific plan’s coverage. So when you’re looking for a new doctor or considering where to get a medical procedure, check your plan’s cost estimator first. You might be able to shop around and save some money.

Many HealthPartners members can sign in to get a cost estimate.

In a doctor’s office, a man speaks with a doctor while the doctor listens and takes notes on a clipboard

Know what to do if you get a doctor referral

When you see your doctor, they might recommend additional care from a specialist or another health care provider. In this case, your doctor will give you a referral. Referrals work as an introduction to someone who can give you the more specific care you need.

A referral from your doctor doesn’t necessarily mean your health insurance plan will cover the new provider. While your doctor is making their best recommendation about your health, they may not be aware of who’s in your insurance plan’s network and who isn’t – and particularly if there’s another provider in your plan’s network who can provide similar care.

If you get a referral, it’s best to:

  • Check to see if the recommended doctor is in your plan’s network
  • Check to see if the recommended service is covered by your plan

Doing these things before you schedule an appointment can potentially save you time, stress and money. For example, if you find out that the recommended doctor isn’t in your network or the recommended service isn’t covered, your doctor and insurer can work together to find options for the care you need.