Insurance Basics: Home

In-Network and Out-of-Network Care

Your plan contracts with a wide range of doctors and other practitioners, as well as hospitals, labs, radiology facilities, pharmacies and other providers. These are the providers in your “network”. Each of these providers has agreed to take your plan´s contracted rate as payment in full for services.

In-Network and Out-of-Network Care
Code Modifiers: How they Affect You

Doctors and insurers use standard codes for each medical service or supply. That helps them communicate about treatments and payments clearly.

Code Modifiers: How they Affect You
Narrow Networks

Health plans negotiate the price of medical services with certain doctors, hospitals, labs and other providers.

Provider Networks

Your plan may contract with doctors, dentists and other healthcare practitioners; hospitals; labs; radiology facilities; pharmacies and other types of providers. These are the providers in your “network”.

When Out-of-Network Care Can be Covered In Network

Receiving care from a provider in your health plan´s network usually costs you much less than going to an out-of-network provider.

Types of Out-of-Network Reimbursement

Most health plans have a “network”, a group of doctors, hospitals and other healthcare providers who agree to take your insurer´s rate.

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IN AND OUT OF NETWORK

When Out-of-Network Care Can Be Covered in Network
PLAN COSTS

Flexible Spending Plans
YOUR RIGHTS

Appealing a Reimbursement Decision
KNOW BEFORE YOU GO

Choosing Your Healthcare Provider In-Network and Out-of-Network Care