There are all types of health care providers and you probably have some that you prefer over others. It’s important to know who is within your Provider Network (also called in-network). Those are practicing clinicians, pharmacies, and labs associated with your insurance plan. When you receive services in-network they are provided at a discounted rate. While some types of insurance plans will allow you to go out-of-network, you could end up paying a significant amount more - or even full price.
Here are some examples of when you may need to check to be sure a provider is within network:
In some of these examples, choosing an in-network provider may seem out of your control. Hospital stays and lab work can get dicey. Your best bet is to advocate for yourself as much as possible. If you have a planned visit, check with your health insurance company or the provider to see if they are in-network. Check to make sure that your health care provider is using network providers for any extra services. In the event of a hospital stay or if you are incapacitated, identify a family member to advocate on your behalf.
Any time you have a health insurance change or are referred to a new provider you should check to make sure they are in your provider network. Most health insurance companies and plans allow you to find this information through your customer portal on their website. You can also go the more traditional route and call your health insurance company OR the health care provider directly.
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The information and materials herein are provided for general information purposes only and are not intended to constitute legal or other advice or opinions on any specific matters and are not intended to replace the advice of a qualified attorney, plan provider or other professional advisor. This information has been taken from sources believed to be reliable, but there is no guarantee as to its accuracy. In accordance with IRS Circular 230, this communication is not intended or written to be used, and cannot be used as or considered a ‘covered opinion’ or other written tax advice and should not be relied upon for any purpose other than its intended purpose