In-Network vs Out-of-Network Providers
What Is a Health Insurance Network?
A network is a group of doctors and healthcare providers (across multiple specialties) that insurance companies build to help save you money.
When a doctor, hospital or other healthcare provider joins a health insurance company's network, they agree to take a lower amount for their care.
- Doctors and providers in a health insurance network are called in-network providers (or participating providers).
- Providers not in a network are called out-of-network providers (or non-participating providers).
To lower out-of-pocket costs, choose providers in your health plan's network.
How Can I Tell if a Provider Is In Network?
Know Before You Go
If you have certain doctors, specialists, hospitals or urgent care centers you like to use, you’ll want to make sure they’re part of a health plan’s network before you purchase or use it. Do not wait until after your appointment or after you receive your explanation of benefits (EOB) to find out.
To see if a doctor, specialist, hospital and other healthcare provider is part of a health insurance's network, you can:
- Use the provider directory—most health insurance companies provide an online tool to help you search for in-network providers, such as CareFirst’s Find a Doctor tool.
- Call the provider or, if in person, show them your member ID card—if a provider says they take or accept your health insurance, they are in network.
- Call Customer Service—you can usually find this number on your health plan's member ID card.
Why Does In Network vs Out of Network Matter?
Knowing whether a provider is in or out of network impacts how much you pay for care.
In addition, understanding what type of plan you have can help you choose which doctors and providers to see to get the best value for your money.
Some health plans, such as an HMO plan, only cover care in network (except in an emergency)—while other plans cover both care in network and out of network.
However, if your health plan covers out-of-network care, staying in network can still reduce the amount you pay for healthcare.