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Are Your Doctors in Your Insurance Network?

February 05, 2013  |   Posted by :   |   General   |   0 Comment»

By Michael Grace

Have you ever gone to see a doctor and left with a hefty bill? Often, insurance covers all or part of medical treatment, however not all insurance companies offer the same coverage for all physicians. Did your doctor’s office tell you that s/he wasn’t part of your insurance’s network? If so, it means you’ll be paying more to see that doctor. Insurance companies work with a “network” of medical providers, which is where the phrase in-network or out-of-network comes from. They offer greater coverage for providers within their networks, hence the network discount.

A network discount, the medical cost that your insurance provides you with regardless of your set deductible, is generally 25-50% of your costs. In other words, say you get injured and go to a doctor within your insurance’s network and the doctor gives you an X-ray, a splint and medications, you will only be charged the copay for the doctor visit and fees for the test and the treatment after your insurance pays their share. However, if you get injured and see a doctor outside of your insurance’s network, you may be charged the entire amount, which could be hundreds or thousands of dollars.

Therefore, your network discount decreases your co-pay and additional fees incurred from diagnostic tests, treatments, medications and more. Seeing in-network doctors helps minimize your paying out of pocket expenses.

What affects your insurance network?

– Doctors efficiency/cost criteria

– Number of people the insurance company has in their network

– Zip code

To understand what network insurance is you need to understand an insurance company’s leverage. The more doctors the insurance has under their umbrella, the better chance of getting a “discounted” medical bill. The more policy holders in your insurance network, the more doctors would be willing to accept your insurance. This process is a trade-off, so make sure that your insurance network includes a variety of specialty and general physicians.

Before you agree to an insurance plan, check to see if your current doctors accept that plan and are part of the insurance’s network.