Insurance Basics: Choosing Your Healthcare Provider

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
Emergency Care and Urgent Care

Your plan´s rules and costs may differ for some types of care. Knowing these rules can help you control your costs and get the right care in the right setting.

Emergency Care and Urgent Care
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”.

Narrow Networks

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

Anesthesia Reimbursement

Anesthesia is used to block pain, relax you or control how awake you are. It is used during surgery or other complex procedures. You may need anesthesia even if you´re not in an operating room.

Receiving Care from an Accountable Care Organization

An Accountable Care Organization (ACO) is a group of doctors or hospitals who have agreed to work together to coordinate and improve their patients´ care

Getting Care from a Medical Home

A medical home is a type of doctor´s practice that uses a team to focus on the “whole person”. It is sometimes called a patient-centered medical home (PCMH).

Out-of-Network Docs at In-Network Facilities

Suppose you receive care in a hospital that is in your health plan´s provider network. You may still get a bill from providers who treated you at the hospital but are not part of your plan´s network.

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.

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.

How to speak with your healthcare provider to make informed healthcare decisions

Visiting your doctor or other healthcare provider? Whether you’re seeing your provider online or in person, good communication between you and your provider is key to getting the most out of your visit.

Mental and Emotional Health

Our mental and emotional health is a vital part of our well-being. If we don´t get the help we need, mental and emotional health problems can hurt our relationships with our family and friends, our jobs and even our communities.

Help for Caregivers

Are you caring long-term for a sick or disabled family member or friend? If so, you may sometimes feel alone and overwhelmed. Luckily, there are resources to help you.

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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

Did You

Know

Most plans have provider "networks", or a group of doctors, hospitals and other healthcare providers who agree to accept the amount your plan pays. If you see providers outside the network, you'll probably pay more.

Did You

Know

Even if your hospital takes your plan, the doctor who treats you there may not.