Understanding Health Insurance: What is a Provider Network?


This is a list of doctors and hospitals that
are connected to your plan. Insurance companies negotiate discounts with these providers.
Stay in-network, and the discounts get passed to you. Go out of network, and you could end
up paying full price. In some plans, like HMOs or EPOs, your insurance would pay nothing
if you go out-of-network. In other plans, like PPOs, your insurance will cover you no
matter where you go, but you’ll pay a lot more if you go out of network. Sound easy
enough? Well, sometimes staying in-network can be tricky! In a hospital, it’s possible
that your surgeon could be in-network, while your anesthesiologist is not. If this happens
to you, don’t be afraid to negotiate with your provider or file an appeal with your
insurer.

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