How to Find Out if Your Doctor is “In Network”

Are you switching health insurance plans? If so, one of the first things you will want to check is which physicians are “in network.” This is especially important if you have a particular physician or specialist that you see would prefer to continue with him or her rather than switching to a new doctor.

Insurance plans often have preferred doctors and may refer to that list of physicians as in network. There may be a separate list of physicians that are out of network. Some health plans may refer to these levels with different terminology like Tier 1 and Tier 2. Whatever language is used, it’s important to pay attention to these lists, because the difference could impact your wallet.

In network or preferred doctors are those that have accepted arrangements with your particular health insurance to be reimbursed for payment. These doctors generally have low, or sometimes no, copay and usually all or most of the work by that physician will be covered by your insurance.

Out-of-network doctors do not have these same benefits. Be sure to carefully read what is covered for visits with out-of-network physicians. These visits may have higher copays, higher deductibles, and you may receive a bill for some or all of the costs. For example, a visit to an in-network primary care physician may have a $15 copay and the rest of the visit cost may be fully covered by insurance, meaning you don’t have to pay anything further. The same visit to an out-of-network primary care physician may have a $30 copay, and the insurance plan may only cover 80% of the cost of the visit, meaning you will get a bill for the other 20%. Out-of-network costs can really add up over time.

So, how do you know if your favored doctor is in network? There are several ways you can find out. A good place to start is the health plan’s website. Most health plans have a “find a doctor” search tool. Search for your doctor there and see if they show up as in network (or preferred or Tier 1) or out of network.

You can also call your doctor’s office directly and ask if your doctor participates in the health plan. They will be able to tell you if the doctor and facility are fully or partially covered.

Once you have your answer, you’ll be able to make a decision about which insurance plan is right for you.


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One Question to Ask in the Emergency Room

When you’re being rushed in to the emergency room after an accident, one of the furthest things from your mind is asking that doctor if they take your insurance. However, in reality, this is one of the first questions you should ask. Most people don’t realize that they can be out of network with the doctors who are saving their lives, or even worse, the hospital in which their life was saved.

Unfortunately, you can’t assume that the physician who is caring for you is in your network. If you’ve ever spent an extended amount of time in the hospital, you know that many different doctors pop in and out of your room all day long. So it’s up to you to ask if they take your insurance; if not, be prepared to pay.

States such as California are making sure patients no longer get bills from out-of-network doctors. As of last month patients will be able to rest easy knowing that if their insurance is in network with the hospital they are in, they will not be treated by any out-of-network doctors. This law is designed to help the patient. So many people are getting hit with out-of-network doctors’ bills, and with the price of insurance already being extremely high, it’s important that we do everything we can to keep costs down.

What do you think about this law? Have you ever had this happen to you? Do they do this in in your state?


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