In-Network Providers and Negotiated Fees

Why using in-network providers saves you money

Important Note: One of the biggest benefits of having a health insurance plan is the ability to pay the “negotiated fee” for medical services for doctors, labs and hospitals.  The negotiated fees are substantially lower than a provider’s regular fees.

For example, insurance companies contract with physicians to keep office visits affordable. They also contract with laboratories and hospitals.  In exchange for lower negotiated fees, insurance companies include providers on their network and then encourage plan members to choose providers from within the network.

Unfortunately, these regular and negotiated fees are not published, and the only way to find them is to look at an Explanation of Benefits (EOB) to see what the doctor submitted (regular rate) and what the insurance company allowed (negotiated fee).

Plan members will pay less for services when they see in-network providers.  If they choose to go out-of-network, they will pay the regular fee and it will be subject to a separate and larger out-of-network deductible.

Important Note: Plan members should always log on to the insurance company website, and use the “Find Provider” tool to make sure their doctor is in-network. Members should also double check by verifying provider is still in-network when calling to make an appointment.