Many people have seen the terms “in-network” and “out-of-network” on health insurance policies and probably wondered what they mean. In a nutshell, your insurance plan has contracted with different specialists, hospitals, labs, pharmacies, etc. These contracted providers are “in-network,” since they have negotiated their rates with the insurance company.
The negotiated rates include both your insurer’s share of the cost as well as yours. Your cost is paid in the form of copayments, coinsurance and deductibles, and the insurance company covers the remaining amount. It’s in your benefit to stay within your insurance company’s established network, since the negotiated rates between the insurance company and healthcare provider are generally lower than what the provider would change, which will likely further reduce your costs.
Out-of-network is another story—insurance companies will generally cover less when you use an out-of- network provider. Your co-insurance rate may be higher, costing you much more out-of-pocket, and some services may not be covered at all. This is especially true with health maintenance organizations (HMO), where you generally will have to pay the full cost of services out-of-network, except in cases of emergency.
Insurance policies are full of terminology that may be unfamiliar and feel overwhelming. A knowledgeable and experienced insurance agent can help you understand these terms and what they mean for you so you can better understand what your costs will be. Benefit Packages has over 20 years in the industry and is ready to help you find a comprehensive policy that suits your budget. We work with reputable insurance companies like Blue Shield of California and we can help seniors find alternatives to original Medicare such as Anthem Medicare Advantage. Call us today at 1-800-356-3615 or visit our website for a quote.