How to Determine Whether Your Doctor is In-Network

As the year comes to an end and many employer sponsored health insurance options come up for renewal, your employer may opt to switch carriers due to a variety of factors. Your employer may choose to switch carriers due to the increasing cost of health insurance, deductible amounts, or even the level of network in the area. If your employer switches their employer sponsored plan and you find yourself with a new carrier, one of the first thoughts you may have is, “Is my doctor in-network?”

female pediatrician performing check-up for a young girl and mother

What Does In-Network Mean?

In the world of health insurance, carriers work within a network of contracted healthcare providers. These contracts limit the financial liability of the carrier for services, allowing the carriers to offer them to the insured at a more cost-effective price point. Providers that have contracts with carriers are considered “In-Network.” As the insured, you will typically pay less out of pocket if you utilize an in-network provider. In-network providers benefit not only the insured who is utilizing the coverage, but the carrier as well.

What Happens if I Go to a Doctor That Is Not In-Network?

If you choose to go to a doctor that isn’t in-network, usually the carrier will pay less of the cost of services, if any at all. Depending on the health insurance plan you are enrolled in, the carrier may not be financially liable for any of the cost of a non-emergent service performed out of network. Therefore, if your primary care provider is out of network, you could be responsible for the entirety of the cost of each visit, whereas if your primary care provider was in network, you may have a lower copay or coinsurance.

How Do I Know if My Doctor Is In-Network?

Every carrier has a different network of contracted providers, so a doctor that is in-network for one carrier might not be for another. The best way to determine if a doctor is in-network is to call the number on the back of your health insurance ID card. All health insurance ID cards have a member services phone number on the back for instances just like this. Calling your carrier’s member services line directly will give you the most up to date information on network status.

As the world of technology increases, many carriers also have online portals where members can research primary care providers near them. You can ask the member services number or your benefits administrator for more information on carrier websites.

doctor monitoring blood pressure on young woman during exam

What Do I Do if My Doctor is Not In-Network?

So, you called member services and they said your doctor isn’t in-network. What are the next steps? If your doctor isn’t in network for your insurance carrier, the best practice would be to work with the carrier’s member services team to find an in-network provider in your area. Losing relationships with doctors that have been built over the course of years can be difficult. However, as the cost of healthcare rises, making sure that you’re choosing an in-network provider may be the best financial decision.

Should I Go to an In-Network Provider for All My Healthcare Needs?

If given the choice, you should always consider an in-network provider. When people think of providers, many only think of their doctor or primary care provider. Below is a non-exhaustive list of other healthcare providers that you could be utilizing in-network.

  • Chiropractic Care
  • Dermatology
  • Physical Therapy
  • Mental Health Counseling

doctor helping patient lift weight as part of physical therapy

Health Insurance Quotes

If you are an employer wishing to offer a comprehensive healthcare package for your employees, or an individual looking to set up a policy for yourself or your family, contact a member of our benefits team here at Cross. Cross Insurance can help you explore your options when it comes to individual or group health insurance. To find out more, contact your local Cross Insurance today.



This article is for general informational purposes only and is not to be relied upon or used for any particular purpose. Cross Insurance shall not be held responsible in any way for, and specifically disclaims any liability arising out of or in any way connected to, reliance on or use of any of the information contained in this article. The information contained or referenced in this article is not intended to constitute and should not be considered legal, insurance, accounting or other professional advice, nor shall it serve as a substitute for the recipient obtaining such advice. The views expressed in this article are that of its author and do not necessarily represent the views of Cross Financial Corp. and its subsidiaries and affiliates (“Cross Insurance”) or Cross Insurance’s management or shareholders.

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