Health Insurance Question – What is the difference between in network and out of network?
On mу health insurance plans I hаνе аn іn network аnd out οf network co-pays аnd deductables. I dont know οr know thе dіffеrеnсе. I hаνе $500.00 іn deductables fοr іn network аnd $1,500 fοr out οf network… Cаn someone please сlаrіfу?
In-network are doctors who have agreed to acknowledge your insurance and your co-pay based on the insurance company’s rate schedule – out-of-network are doctors who are not registered with your insurance company as providers.
Doctor and hospitals make contracts with individual insurance companies to cover the insured patients at a discounted rate from their list price. Gets patients for the docs and hospitals and reduces cost for the insurance companies. This is called a “network.”
If you go to a doc or hospital that does not have a contract with your insurance company, then you have gone “out of network” and it will cost you more. And, if a doc calls in someone to consult with you on your care, and that doc is not in your network, it will cost you more. And his fee may not even count toward your deductable. Lots of traps out there. Gotta be real careful!