Insurance plans today are designed to provide affordable medical services when you go to providers in the network.
Insurance companies contract with local physicians to negotiate lower costs for you and include them in the network. By going to these “in-network” providers you get the lowest cost for medical services.
Here is a hypothetical example:
- Standard fee for physician $150+
- In-network negotiated fee $75
If you choose a provider who is not on the network—e.g., an “out-of-network” provider—you will pay significantly more for those medical services compared to in-network providers.
Your insurance plan has a separate—and higher—deductible for out-of-network services. In addition, you will also pay a higher co-insurance percentage for costs above the deductible; and finally there is a separate—and much higher—out of-pocket maximum.
We always recommend you go to the insurance company website to verify your doctor, laboratory or hospital is in the network of providers. It makes dollars and sense.