Why the provider you pick can change what you pay.
A health plan's network is the group of doctors, hospitals, and other providers that have agreed to accept negotiated rates from your insurance company. Staying in-network is almost always cheaper because your insurer has already negotiated the price down and agreed to cover a set share of it.
When you see an out-of-network provider, there's no negotiated rate in place, so you may be billed the provider's full charge. Your plan may cover little or none of that cost depending on your plan type, and some plans, like HMOs, may not cover out-of-network care at all except in emergencies.
Before scheduling an appointment, it's worth confirming directly with both your insurance company and the provider's office that the provider is in-network for your specific plan, since network status can change and isn't always reflected instantly online.
Federal law generally protects you from surprise out-of-network bills for emergency care and certain situations at in-network facilities, so emergency situations are typically handled differently than a routine, planned visit to an out-of-network provider.
Have more questions? Visit our FAQ page or read the full Coverage Guide.