There are lots of reasons why you should stay in-network when seeking medical care. But, too truly understand the reasons, you must first understand what a health insurance network is. Once that piece is in place for you, the rest will make much more sense.
When a doctor is considered in-network, it means that he or she has contracted with your insurance company to provide medical care to their members. Because of this contract, it usually means you end up paying less for health care services provided by that physician. Should you see a doctor who has not contracted with your insurance provider, that visit and physician would be considered “out of network” and could cost you quite a bit more money. It is important to note that the terms “in network” and “out of network” also pertain to lab work, pharmacies, specialists, etc.
Let’s dive in and explore some areas you should be aware of when it comes to health insurance and staying in-network.
How to Find In-Network Providers
Insurance companies usually have an online directory that you can use to find which doctors are in their network. If you don’t remember getting a directory or you lost the link, I have a handy tool you can use to find doctors in your network. To gain access click HERE.
Why Would You Go Out Of Network?
There are many reasons you may need to go out of network. Here are just a few:
- Life doesn’t always go as planned. Medical emergencies may require you to get immediate attention outside of the network.
- In some cases, your primary or treating doctor may want to refer a specialist. Sometimes that specialist may not be included in your network. If that’s the case, do your research. Make sure the specialist you are being referred to is truly the best resource for your circumstances. In some cases, you may be able to speak to your insurance company about getting out of network care at in-network pricing.
- Changing providers would jeopardize your health.
- Proximity to adequate care. The ACA requires insurers to maintain provider networks that are within a reasonable distance and time to the member.
- Natural disasters forcing members to evacuate to areas outside of their network. In these cases, some insurers will extend in-network pricing.
What Happens If Your Get Hurt or Sick When Traveling Domestically?
This is a really good question! At some level, all plans have some sort of out-of-state coverage when it comes to emergencies. Unfortunately, there isn’t a clear definition of what an emergency is. What may seem like an emergency to you may not be considered an emergency by your insurance company. Before you go on your trip, make sure you understand what your specific plan covers when you travel and what is considered an emergency versus what is not.
Making Sure You Are Covered When You Travel
If you travel frequently or reside in different states throughout the year, you may want to consider opting into supplemental coverage. Supplemental coverage is a policy you purchase to help pay for things like services and out-of-pocket expenses that your regular insurance does not cover. Some supplemental insurance plans will pay for out-of-pocket medical expenses, such as deductibles, copayments, and coinsurance. When looking into supplemental health insurance, make sure you do your homework. Determine whether the coverage will be sufficient when you travel out of state.
Always take the time to determine whether or not the doctor, pharmacy, lab, etc. is in your network or not. This one detail can mean the difference between a copay and a huge medical bill.