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September 15, 2010

Difference Between In-Network vs Out-of-Network Health Insurance Coverage

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To read more about general ideas (copays, deductibles, etc) of how health insurance coverage works, click here.

There are large health insurance companies that offer health insurance plans throughout the United States like Aetna, Anthem, Cigna, etc.

HOWEVER, just because you have one of these companies, does NOT mean that the health insurance benefits that apply in the state you live in apply to the other 49 states in the United States. Sometimes, even within the state, coverage may vary depending on whether the physician you see is IN-NETWORK or OUT-OF-NETWORK with your health insurance plan.

IN-NETWORK coverage means the doctor you see participates fully with your health insurance plan and the copays, deductibles, coinsurances, etc specified on your health insurance card applies.

OUT-OF-NETWORK coverage means that the doctor you see participates with your health insurance plan, but you will have to pay a MUCH larger portion of the bill as your health insurance plan will only cover a much smaller fraction of the charges.

In order to determine whether the doctor you will like to see is in-network or out-of-network, you will have to call your health insurance plan and ask.

Please be aware that your health insurance plan may not even offer out-of-network benefits in which case you are responsible to pay for everything if you see a provider who is not in-network.

A final last point is that some physicians may not even be in-network OR out-of-network with your health insurance plan. In this case, EVEN if you have out-of-network benefits, you will be responsible for all charges out-of-pocket.

To see what insurances we participate with in our office, click here. Just remember that we may be out-of-network, ESPECIALLY if you live in a different state from Virginia.

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