Trying to find and use an in-network provider can get frustrating. While you may have done your due diligence and made sure a hospital or doctor’s office is in-network, the actual medical provider may not be. When you’re unaware that you’ve used an out-of-network provider, getting blinded with out-of-network fees can be overwhelming. And you’re not the only one facing unexpected charges. In fact, “63% of American adults indicate they have received medical bills that cost more than they expected.”

In-Network vs. Out-of-Network

Verifying In-network providers:

  • Check your insurance company’s and provider’s websites.
  • Call your insurance company and provider.
  • Call your agent.

In short, networks are created by insurance companies. Insurance companies ask providers if they will charge agreed upon rates for specific services. If the providers agree to these rates, they can be called an “in-network provider.” If the providers do not agree to join the network, the health insurance company will label them “out-of-network.”

Now, here’s where it gets complicated. An in-network hospital or medical office can contract out-of-network providers. This means that while you may have confirmed the facility you are going to will be fully covered, you could still be using an out-of-network provider’s services.

How to Verify In-Network Providers

Even if a doctor’s office or hospital facility contracts out-of-network, there is a way to ensure you’re using in-network providers: verify before your visit. But, how do you verify that a facility and the practitioners you will be visiting are in-network providers?

  • Check your insurance company’s website. Many insurance companies will post in-network providers for the plans they offer. However, these web pages aren’t always updated. If you do use this feature, make sure you are comparing networks for your specific policy and not just for the company.
  • Check your provider’s website. Healthcare provider websites (like hospitals and doctor’s offices) may also list the networks they are part of. However, they may also be outdated and may not list which network each doctor participates in.
  • Call your provider. If you are visiting the doctor or planning an operation, call the facility you will be visiting. You can ask the office to verify that all of the providers you will be seeing are part of your plan’s network.
  • Call your insurance company. You can also call your insurance company to verify in-network providers. Providing your insurance company with your provider’s tax ID and your plan information during this call will help your insurance company verify if a provider is in your specific network.
  • Call your agent. A licensed health insurance agent can help you with your year-round questions and concerns. Whether you are looking for a new plan and want to keep your doctors, want to try a new doctor, or have to schedule an operation, an agent can help point you in the right direction.

Learn More About Health Insurance

Using in-network providers is only a small part of saving money on your medical expenses. Learn more about health insurance and how you could save money by visiting HealthMarkets’ resource center. Or, call an agent today at (800) 429-5058.


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