Finding a doctor in your health plan’s network (2024)

Most insurance plans provide covered access to a certain network of providers and locations. There are several advantages to getting care in network:

You’ll receive a discounted rate
Your insurance will likely cover more of the total cost of services
You can expect high-quality care at a fair cost, since your insurance company will have carefully vetted the providers

How do I find a doctor who’s in my network and takes my insurance?

There are several ways to check whether your doctor is in network:

Check often, provider networks can change

Insurance companies routinely review and amend their networks to make sure they remain low cost and high quality. So, it’s a good idea to make sure your doctor is in your network before scheduling an appointment or switching plans. Most insurance companies have a variety of provider networks that pair with different plans. This gives their members more choices so they can find an option with the right combination of premium, out-of-pocket costs and network. It also means that you should determine if your regular doctors are in the network of any plan that you’re considering switching to, even if it’s with the same insurance company or employer.

Use an in-network provider for preventive care services

It’s especially important to see an in-network rather than an out-of-network doctor for preventive care services. This is because preventive services are usually covered 100% by health insurance, but only when you receive care from a doctor or clinic in your network. Preventive care includes your yearly exam, immunizations, health screenings and other certain steps you take to stay healthy.

What if I want to get a cost estimate for my health care?

Most insurance carriers have price transparency tools that can help you estimate what you’ll pay out of pocket, both for in- and out-of-network care. It’s a good idea to check, since providers in the same network can charge different rates for the same services or prescription drugs, and since rates can vary depending on where you get care, like in a doctor’s office versus a hospital. Check with your plan to see what your options and resources are.

Many HealthPartners members can sign in to access our cost estimate tools online. These estimates reflect your specific coverage, so you find the care you’re looking for at a price that’s right for you.

Can doctors look up your insurance?

Yes, doctors can look up your insurance, but it’s best to touch base with your insurance company for questions regarding your specific coverage. Your doctor won’t have the level of knowledge for your plan or network that your insurance company will. Save time, money and potential conflict by getting clarification on your coverage from the experts at your insurance company.

The difference between doctor referrals and insurance referrals

After a primary care visit, your doctor may suggest you get specialized or ongoing care from another provider and provide a doctor – or physician – referral. Having a doctor referral doesn’t necessarily mean your care at the other provider will be covered by your insurance plan. You need to first check if the provider or clinic your doctor recommends is in network. If it is, it will be covered under the appropriate benefit within your plan. If not, you will need an insurance referral.

If needed, your doctor will work with your health plan to submit an insurance referral for your next steps. If approved, this means insurance will cover the cost even though the provider or clinic is not in your network. This can happen in instances where a rare type of care is needed or if your in-network options are too far away. Insurance referrals aren’t always approved, so be sure to confirm before you get your care so you know what is going to be covered.

Finding a doctor in your health plan’s network (2024)

FAQs

What does it mean for a doctor to be in your network? ›

A provider network is a list of doctors, other health care providers, and hospitals that a plan contracts with to provide medical care to its members. They're known as “network providers” or “in-network providers.” A provider that isn't contracted with the plan is called an “out-of-network provider.”

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Why is it important to know if a doctor or medical facility is in-network? ›

In-network doctors and facilities have agreed not to charge you more than the agreed-upon cost. Your share of costs is different—and usually higher. A copay is the amount you pay for covered health services at the time you receive care. There are no copays when you use a doctor or facility that is out-of-network.

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Why is it so hard to find a good doctor? ›

Where did all the doctors go? There are a number of factors at play here, but “the short answer is we don't have enough of them, because we're not training as many as we need,” says Micheal Dill, director of workforce studies at the AAMC.

What kind of private health insurance requires you to use a doctor that is in-network in order to receive insurance coverage? ›

Health Maintenance Organizations (HMOs)

You must use providers in the HMO network. Usually, you must have a primary care doctor. This doctor provides your basic care and coordinates referrals to specialists. To enroll in an HMO, you must live in the area the HMO serves.

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What does it mean when insurance says in-network? ›

In-network refers to a health care provider that has a contract with your health plan to provide health care services to its plan members at a pre-negotiated rate. Because of this relationship, you pay a lower cost-sharing when you receive services from an in-network doctor.

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What happens if I see a doctor outside of my network? ›

If you choose to see a doctor who is outside the preferred network, you will generally have to pay a larger portion of the bill than you would for an in-network provider, but most plans will still cover a portion of the bill. With a PPO, you will have access to out-of-state providers that are considered in-network.

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How do you know if a doctor is good or bad? ›

Such a checkup is simple and helps a consumer make an informed choice when choosing a doctor. To determine a doctor's status, go to the Medical Board's website or call (800) 633-2322 and someone at the Medical Board will look up the doctor for you. To use the website, click on "License Search" on the home page.

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What is the best website to find a good doctor? ›

The 10 Most Popular and Recommended Doctor Review Websites

HealthGrades.
WebMD.
RateMDs.
Yelp.
ZocDoc.
RealSelf.
CareDash.
Facebook.

More items...

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Which is better, HMO or PPO? ›

Is an HMO or PPO better? An HMO is better if you're looking for cheaper health insurance costs, but a PPO is superior if you want the option of out-of-network care and don't want to get primary care physician referrals to see a specialist.

What are the two most common health insurance plans? ›

Before choosing a health insurance policy for yourself, your family, or your employees, you must know what types are available. Some popular health insurance policy options are: Preferred provider organization (PPO) plans. Health maintenance organization (HMO) plans.

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Which health insurance is the best? ›

Blue Cross Blue Shield. : Best all-around policies.
Oscar. : Excellent plan options.
Kaiser Permanente. : Lowest average deductible.
Cigna. : Excellent value.
Aetna. : Lowest premiums.

May 2, 2024

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What is the negative side of seeing a doctor who is out-of-network? ›

Providers that are out-of-network are those that do not participate in that health plan's network. The provider is not contracted with the health insurance plan to accepted negotiated rates. This mean that patients will typically pay more or the full amount for the service they receive.

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Why do doctors join networks? ›

Physicians enter the field to make a difference in people's lives, and joining a CIN can help them achieve this goal more effectively. By collaborating with a diverse group of health care professionals within the network, independent physicians gain access to a wealth of knowledge, experience and resources.

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What does it mean if a physician is out-of-network? ›

This phrase usually refers to physicians, hospitals or other healthcare providers who do not participate in an insurer's provider network. This means that the provider has not signed a contract agreeing to accept the insurer's negotiated prices.

What is the meaning of DR in networking? ›

A disaster recovery site can be used to recover data from the most recent backup or a previous point in time. Organizations can also switch to using a DR site if the primary location and its systems fail due to an unforeseen event until the primary one is restored.