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Is Your Doctor In-Network?

February 2, 2018

Once you have health insurance, the next step is to use that coverage to see a doctor. However, it is important to understand which providers are “in-network”. All insurance companies, whether they are through Medicaid, the Marketplace, an employer, or a private plan, have a provider network. This means that the insurance company has set up agreements with specific doctors and practices to lower prices for you, the patient. It is important that you go to a doctor who is “in-network” in order to pay less for any services when you go to the doctor, or you could end up paying the full cost out of your own pocket.

After signing up for a health insurance plan, you should receive a welcome packet from your plan with your new insurance card and an explanation of your member benefits. Often, you will need to call to member services to determine what doctors in your area are in-network so that you can choose a primary doctor. If you already have a doctor you are familiar with and wish to stay with that same doctor, it is important that you ask the doctor which plans they accept or are in-network with before you sign up for a plan.

Another thing to watch out for is tiered networks. Some plans may have different levels of agreements or tiers. A tier 1 doctor will charge you less than the same service as a tier 2 or tier 3 doctor or hospital. Likewise, it is a good idea to check when you are referred to a specialist for another service to ensure that doctor is also in-network.