Health insurance is designed to help you access quality care while offering financial protection. But not every healthcare provider is covered by every health insurance plan. That’s why it’s important to know what — and whom — your policy covers. Read on to learn how to check if a doctor is in-network.
What Does “In-Network” Mean and Why It Matters
An in-network provider is a doctor, hospital or other healthcare provider that accepts your health insurance plan. To be included in that plan, in-network providers have agreed to provide a discounted rate for their services and care.
A provider or hospital that is out-of-network, on the other hand, doesn’t have a contract with your health insurance company to provide discounted care. That means your health insurance may not cover all or part of the bill, leaving you, as the patient, responsible for payment.
The amount that your health insurance provider will cover for an in-network visit vs. an out-of-network visit will depend on the type of plan you have. A PPO (Preferred Provider Organization) plan, for example, will often cover out-of-network services, but the cost may be higher than in-network care. Whereas an EPO (Exclusive Provider Organization) plan usually won’t pay for out-of-network care, except in the case of an emergency. That means the entire cost could fall to you, the patient.
How to Find an In-Network Doctor: 4 Ways
Your health insurer will share a list of providers who are covered by your plan — you just have to know where to find that list. Here’s how to tell if a doctor is in-network.
1. Visit your health insurance member account
On your member account page, you’ll be able to peruse providers and determine whether or not they’re in-network. In the case of Blue Cross and Blue Shield of Alabama, for example, the Find a Doctor page allows members and guests to search thousands of medical professionals and facilities to find in-network providers that meet their needs.
2. Visit your health insurance app
If you’ve downloaded your health insurance app you should be able to search for a doctor in your network there, as well. Blue Cross and Blue Shield of Alabama members can access the Alabama Blue app here: https://www.bcbsal.org/web/mobile.html.
3. Call the Healthcare facility or provider
If you’re unsure whether or not a doctor or facility is covered by your plan, call their office and ask. Have your health insurance member card ready so you can share the important details they’ll need in order to answer your questions.
4. Call your insurance provider
Still wondering how to know if a doctor is in-network? A health plan representative will be able to tell you. Simply call the customer service number listed on your card and ask. For Blue Cross and Blue Shield of Alabama members, the number to call is 1-800-292-8868, and for non-members, the number is 1-888-267-2955.
Check Whether Your Doctor Is In-Network: 5 Questions to Ask
Provider networks can change, so it’s always a good idea to call your provider or the health insurance plan before your appointment to confirm whether the individual or facility is still in-network. While you’re on the line, you could also inquire about the services and care you may receive to be sure they, too, are covered by your plan. If you’re unsure of what questions to ask to determine if your provider is in-network, here are some examples that may help guide you:
- “I want to be sure that my doctor is covered by my health insurance. Could you confirm that?” Or, “Could you confirm that you participate in my health insurance plan?”
- Have your member card ready, so you can provide the details they need to get you an answer.
- “Is it just my specific doctor who is covered, or is the entire facility?” Or, “Are there other providers at your facility whom I might see who aren’t in-network?”
- Sometimes patients may see additional providers at a hospital or clinic. If they’re not all covered by your plan, specify that you’d like to see only in-network providers.
- “Will the services I’m receiving, including labs, diagnostic imaging, and other procedures, also be billed in-network?”
- Lab work, MRIs, CTs and other tests can be quite expensive. Be sure to confirm that your plan will cover any of the services you might need.
- “Do I need preauthorization for this visit, or a referral, in order to be covered in-network?”
- Some plans require prior authorization or a referral to receive care. By asking this question in advance, you’re more likely to avoid any costly surprises after you’ve received care.
- “If I have a question about billing, whom should I contact?”
- Make note of the information they share. That way, you’ll know what to do in the event that the charges aren’t what you expected.
Learn More About Using Your Health Insurance
When you understand how health insurance works, you’re able to get the most out of your benefits and make more informed choices about your care. That includes knowing how to choose an in-network provider and what questions to ask along the way.
Want to learn more about using your health insurance? The following articles are a good place to start:
How Health Insurance Works: Feel Confident Using Your Coverage
How to Get Health Insurance if You Aren’t Covered
Qualifying Life Events (QLE): How to Remain Insured Outside of Open Enrollment
To Prepare for a Health Emergency, Take These 4 Steps
