It is important to understand the ins and outs of health insurance provider networks so that you can make informed decisions about your care. By understanding your coverage, you can help to keep your health care costs down.
What Is a Health Insurance Provider Network?
In-Network: Health insurance companies contract with doctor’s offices and hospitals to pay lower prices for their services, in return for more patient traffic. The provider agrees to accept the lower rate, which includes your copay or coinsurance, as payment in full. These providers – doctors, specialists and hospitals – are considered in-network.
Out-of-Network: If a doctor or hospital is not contracted with your health insurance plan then they are out-of-network. This means there is no discount applied to the service you receive from that provider and you may be charged a much higher rate than if the provider had been in-network. The APWU Health Plan covers out-of-network services but you will be responsible for higher coinsurance and deductibles.
Why Does It Matter?
When you see a network provider, you can feel confident that s/he or the facility has met certain qualifications, such as educational background, safety measures and board certifications, required by your insurance company. This assurance of quality is in addition to the in-network cost savings you will receive by going to your insurance company’s approved providers.
How your plan pays for out-of-network services depends on the type of coverage you have. You can learn about the APWU Health Plans cover services on our website https://www.apwuhp.com/our-plans/compare-plan-options/ or in our plan brochures.
The type of health insurance plan you have will determine how much you pay for in-network and out-of-network care. For example, HMO plans typically require you to use in-network providers for all care, while PPO plans like the APWU Health Plan allow you to see out-of-network providers for a higher cost.
Even if a provider is in-network, you may still have to pay a copay or coinsurance for their services. The amount of your copay or coinsurance will vary depending on the type of service you receive and your health insurance plan.
Here are some tips for staying in-network:
- Do your research before you make an appointment. Use your health insurance plan’s website or call the customer service number on the back of your card to find out if a specific provider is in-network.
- Ask your doctor if they are in-network. If you are already seeing a doctor, be sure to ask them if they are in your insurance network.
- Just because a provider accepts your insurance it doesn’t necessarily mean that they’re in the insurance network. Going out-of-network is expensive.
- Be clear about your coverage when you make an appointment. When you make an appointment, be sure to tell the provider that you want to see an in-network provider.
- If you are ever in doubt, ask. If you are not sure whether a provider is in-network, don’t be afraid to ask. It is better to be safe than sorry.
For more information about how the APWU Health Plan covers in and out-of-network care please review our plan brochure. If you don’t have a brochure you can download one online, request one on our website https://www.apwuhp.com/request-a-brochure/ or call our Customer Service and we will mail you a brochure.