In network and out of network: What’s the difference?

Health insurance 101 terms to know

When you’re signing up for a health plan or looking at your plan benefits, you’ll often see “in network” and “out of network” when referring to providers. Knowing the difference between in-network and out-of-network providers can help you get the most out of your benefits and save you money.

What is an in-network provider?

An in-network provider is any provider who is part of your plan’s provider network. A provider network is a group of doctors, hospitals, pharmacies and clinics who agree to see you as a patient and send us the bill for your care. You save money when you see in-network providers for your care because we’ve negotiated the prices for many services to help keep your healthcare costs low.

What is an out-of-network provider?

An out-of-network provider is any provider who isn’t in your plan’s network. You will pay higher out-of-pocket costs if you see an out-of-network provider. Depending on your plan, you may need a referral to see an out-of-network provider, or you may have no out-of-network benefits covered except for emergency care. Be sure to check your plan documents by logging in to the member portal or the member app to learn more.

Choose an in-network provider

Choose an in-network provider to be your PCP so you can get the most out of your benefits. Your PCP is your partner in health and can help you stay or get healthy. Make sure to schedule an annual wellness visit with your PCP so they can catch any potential health issues early.

You can find an in-network provider in a few simple ways:

Member portal

Use our Find Care tool on our member portal to find an in-network provider. Make sure you’re logged in so you can see providers in your network and search for care by network, provider name, specialty or location.

Member app

Download the Blue Cross of Idaho member app. Launch the app and select Find Care and then search for a provider by name or select Medical Care to see a list of provider types to choose from. You can download the member app from the App Store or Google Play.

Blue Cross of Idaho Customer Service Department

If you don’t have internet access, you can always call the Blue Cross of Idaho Customer Service Department at the number on the back of your member ID card. Our customer advocates can help answer any questions you may have about a provider’s specialty, education or credentials.

Want healthy tips? Download Sharecare.

Blue Cross of Idaho members now have access to Sharecare, an app to help you eat better, lower your stress levels and be more active! To get the app, visit bcidaho.sharecare.com to create your Sharecare account, download the app and take the RealAge® Test. Do not download the Sharecare app directly from the App Store or Google Play.

 

Disclaimer: This wellness program is administered by Sharecare, Inc., an independent company that provides health improvement management services to Blue Cross of Idaho members. Sharecare, Inc., does not provide Blue Cross of Idaho products or services and is solely responsible for the health improvement management services it provides.

 

Posted: June 15, 2022