What’s the deal with seeing a doctor “in the network”?

If you have health insurance, it’s a good bet you have a “network” that goes along with it. Most health insurance plans operate on a model of partnering with hospitals, doctors and other healthcare providers to form a network. Being part of a network helps increase patient volume for the doctors, and in turn, they are able to offer lower rates to the insurance company.

Whether they use the term “preferred,” “in-network,” “PPO”, or “participating”, these doctors are part of the health insurance company’s network. Many health plans let you to see doctors and providers that are NOT part of the network, but you typically pay more money if you do.

So, is having a network a good thing, or just a giant restriction of my freedom?

You really do save money by seeing doctors that are in your network, but just how much money you save might shock you. Let’s say you need to have your knee looked at, and you are considering three different doctors – one that’s in your network, and two that are not.

Dr graphic

After looking at these scenarios, you may be saying, “But how would I know what my doctor charges?” Ah, yes. Welcome to a new day in health care. A day where we actually have to practice some consumerism and call our doctors and ask what they charge. If you’re like me, the thought of this makes you cringe. I would ask a contractor what they would charge to build my kitchen cabinets before I gave the okay. But asking a doctor what they charge? Yikes. That falls well outside of my comfort zone.

Luckily for me, and for you if you’re the same way about this, doctors, hospitals and other health care providers are pretty used to this and usually have no problem telling you about your potential charges. And don’t forget, you would not normally be talking to the doctor herself, you’d be talking to her administrative staff who deal with billing all day long.

Your health insurance company can also give you a hand here. No, seriously, trust me. They don’t want you to be shocked by your bills either. They’d much rather have a call with you explaining what your plan covers and how much it will pay, than to get a call from you in a state of shock and outrage because you thought your plan would pay more.

So the takeaways here are:

  • Know if your doctor is in or out of network before you go
  • Ask what your doctor charges so you can estimate what you will end up paying
  • Dig up your health plan summary (or call your insurance company) and find out all the details about seeing a doctor who is out of network.
Leave a comment

4 Comments

  1. Picky Eater

     /  July 31, 2012

    I know – Dr. House is awesome! I’m sure he’s the only one who can diagnose my chocodilitis. What, with those piecrcing blue eyes of his, I’d even pay the out-of-network costs to see him.

    Reply
  2. Chocolate Loving Quilter

     /  July 30, 2012

    This was a great breakdown of a tricky idea. I especially like the scenarios. I wish Dr. House was in my network!!!!!!!

    Reply
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