Health plans often reference their provider networks, describing providers as either in-network or out-of-network. Provider networks include a range of professionals, from nurse practitioners to physical and occupational therapists, in addition to both primary care physicians (PCPs) and specialists. When a provider is in a plan’s network, it means that the plan and the provider have a contractual relationship. These relationships guarantee certain fees for services and other details of how the provider will interact with a plan and its members.
In-Network and Out-of-Network Providers
In-network providers generally cost you less than out-of-network providers do. Because of their contractual relationship, you will pay lower copays or coinsurance for the services you receive from in-network providers.
Under most circumstances, if you have an HMO plan (which stands for Health Maintenance Organization), you are required to choose a PCP from your plan’s provider network, and you’ll probably need to use in-network providers to ensure that your plan will pay for any covered services you receive. If you have a PPO (Preferred Provider Organization), your plan may pay for covered services from out-of-network providers, as long as you meet certain requirements, and you probably won’t need to choose a PCP. Either way, understanding your plan’s provider network can save you money.
Getting More from Your Network Providers
Some carriers, including Independence Blue Cross health plans, create preferred provider programs for high-quality, efficient providers. Participating providers are chosen for these preferred provider programs because they meet specific criteria and certain quality metrics. Physicians and other providers in these programs come from some of the largest and most respected practices.
If you choose to see one of these preferred providers, you may pay less for your visits, too! Contact your plan to find out how your providers are being measured, and how you can make these preferred provider relationships work for you.
Website last updated: 1/8/2019
Y0041_HM_19_73133
Accepted 2/15/2019
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