“In-Network” Healthcare Providers Vs. Those Who “Accept” Your Insurance: What’s The Difference?

Recent changes to the U.S. health insurance system have made it possible for upwards of 20 million more Americans to obtain insurance coverage than in the past. But the simple fact that you have health insurance doesn’t necessarily mean you’ll always be able to benefit from the coverage. If a physician or specialist is out of your network, you’ll be responsible for the coinsurance payment — a percentage of the treatment’s full price after your plan’s deductible has been met. Therefore, out-of-network care will typically cost more (sometimes a lot more) than comparable care you’d receive from a doctor within your insurance network.

That’s because in-network doctors have entered into a contract with your insurer to accept discounted (also called “negotiated”) rates for patients who are covered by that insurer’s plans. This agreement is actually a win/win for everyone involved. Your insurance company drives their customers to in-network healthcare providers for treatment, and in exchange, these providers offer discounted rates of care to the insurance company. And of course, patients receive high-quality care that’s covered by their insurance company, which usually makes treatment much more affordable and accessible.

Knowing this, the choice may seem simple: always see an in-network doctor. But that’s the tricky part. Some healthcare providers will say they “accept” your insurance, which might make you believe they’re in your network. Don’t assume that’s the case. Unfortunately, some out-of-network providers will use this language to convince you to come to them for treatment when, unbeknownst to you, they don’t have an agreement with your insurer. When they say they “accept” or “take” your insurance, all they’re actually saying is that they’ll accept your insurance company’s partial payment for the services you receive — not that you’ll get a discounted rate for your care.

In fact, these out-of-network providers can essentially charge you any rate they see fit, and these charges will not go towards your deductible. While your insurer will likely pay for a portion of your care, you’ll then be billed for the difference. With an in-network provider, your doctor can’t do that. In some cases, this difference for which you’d be responsible could be thousands of dollars — which would be a very unwelcome surprise upon opening your mail.

It’s vital to understand that “accepting” insurance and being in your insurance network is not necessarily the same thing. Just because your healthcare provider says they accept BlueCross BlueShield, United Healthcare, or other insurance doesn’t mean they have an agreement with these insurers to provide you with a discounted care rate.

So how do you know if your provider is actually in your network? Just call the customer service number listed on your insurance card to find out about a specific provider and whether or not they’re actually in-network. The small amount of time it takes to check will be well worth it; the answer could end up saving you hundreds or even thousands of dollars on your next medical visit.