News Seth Stratton | 5 years ago

What’s a Provider Network? And Why Does It Matter?

Get the scoop on one of the most important – but often overlooked – parts of your health insurance plan. 

How It Works

A network is a group of doctors and hospitals that are part of a health insurance plan.* Your plan’s network can affect how much you pay for care from the doctors you want to see. Two important things to know:
  1. Seeing a doctor who is not in your network means you may have to pay higher out-of-pocket costs.
  2. Going to doctors and hospitals that are in your plan’s network keeps your out-of-pocket costs down.
It’s important to know which doctors and hospitals are part of a health insurance plan before you decide if it’s the right plan for you.

Why It Matters

Receiving care from out-of-network doctors or hospitals usually means you'll have to pay more for your care, depending on your particular insurance plan. For example, most health insurance plans fully cover an annual preventive exam when you see an in-network provider.  This means you would pay $0 out of pocket for your exam. If you see an out-of-network provider for the same preventive exam, and your insurance plan offers no out-of-network benefits, you would need to pay the full price out of pocket for the exam.

How to Choose

When you’re choosing the doctors and hospitals you want in your network, think about the care you want and need. Your health insurance plan’s network should give you and your family:
  • Easy access to a primary care doctor near you
  • Convenient urgent care locations and other options for quick care
  • Access to advanced specialty care (like heart, cancer or pediatric treatment)
  • Connected, coordinated care across the different doctors, hospitals and locations in your network

Some Important Exceptions

If you have a medical emergency, your insurance plan may cover treatment no matter where you go. Plus, if you can't get the treatment you need in your network, your insurance company may give you approval to go to an out-of-network doctor or facility. If you get approval, they'll cover the treatment, but you may have to pay the remaining cost to the doctor or facility. Want to learn more? Take a closer look at your options. *Carolinas HealthCare System hospitals provide services to all patients seeking treatment for an emergency medical condition, regardless of their insurance plan or ability to pay for those services.