Insurance guide
Understanding Insurance Networks
Choosing an in-network doctor is one of the easiest ways to keep costs down. Here's what insurance networks are, what the plan types mean, and how to avoid surprise bills.
In-network vs out-of-network
In-network providers have a contract with your insurance company and charge negotiated rates. You'll usually pay a copay or coinsurance. Out-of-network providers haven't signed a contract — they can charge whatever they want, and your plan may cover little or nothing.
Plan types
- HMO — Lowest cost. Requires a primary care doctor and referrals. Out-of-network care is generally not covered except for emergencies.
- PPO — Higher premiums but more flexibility. See specialists without referrals; out-of-network care is partially covered.
- EPO — Like a PPO without out-of-network coverage. No referrals required.
- HDHP + HSA — Lower premiums, higher deductible. You pay full negotiated rates until the deductible is met, then insurance kicks in.
- Medicare — Original Medicare (Parts A & B) accepted by most doctors. Medicare Advantage plans have their own networks.
How to verify a doctor is in-network
- Search your plan's online directory.
- Call the member services number on your card.
- Call the doctor's office and confirm both the doctor and the practice are in-network for your exact plan name.
- Get the confirmation in writing or note the date, time, and rep's name.
Avoid surprise bills
Even at an in-network hospital, some providers (anesthesia, radiology, ER physicians) may be out-of-network. The federal No Surprises Act protects you in emergencies and most non-emergency hospital care — but you can still be balance-billed if you sign certain waivers. Don't sign anything you don't understand.