When you to visit a doctor, hospital, outpatient health care facility, pharmacy or specialist, there’s lots to consider. You need to weigh factors such as how close they are to where you live, do they stay open late or on weekends, will they offer convenient options like virtual care and more. Not least of all, you might also wonder how affordable your care will be. Keeping all this in mind— just how important is staying in-network versus going out-of-network for your care?
What is a network—and why is it important?
Simply stated, a provider network is a group of providers who agree to accept your plan’s insurance and offer services at a certain rate. This group may include doctors, hospitals, laboratories, specialists or other health care facilities.
Networks can be comprised of providers from all over, or be more localized, serving only specific communities.
The value of staying in-network
Why is there value to visiting providers in your network?
Staying in-network first helps you ensure your care will be covered. But it will also likely save you significantly on costs. Working with your health plan, in-network providers offer you negotiated rates that are discounted, meaning care will ultimately cost you less. You can benefit from lower copays, lower coinsurance and even lower maximum out-of-pocket requirements or deductibles. This can add up to thousands in savings over time versus getting the same care from out-of-network providers. Owing less can give you peace of mind, so you can focus simply on your health, not on your pocketbook.
But staying in-network isn’t just about saving money. It’s also about getting better access to the care you need. Visiting in-network providers can put you on the path to better, more coordinated care.
Simplifying in-network access
In addition, it should be easy for you to choose doctors, hospitals and facilities—no matter where you live or work. For instance, do you have access to the primary care doctors, specialists, dentists, etc. you wish to see? Does your network include access to progressive care options, such as walk-in or urgent care clinics, surgery centers, behavioral and mental health providers and more?
At Meritain Health®, our focus on providing network access helps members receive care when and how they need it, in-person or virtually.
One of our most utilized networks, the Aetna Choice Point of Service II® provider network, gives access to:
- 9 million health care professionals across the country.
- 277,000 primary care physicians.
- Over 307,00 behavioral health specialists.
- 6,200 hospitals with proven track records.
- Over 497,000 physician specialists.
Plus, it includes:
- Institutes of Quality/Excellence highlighted for their quality and efficiency.
- Convenient MinuteClinic® and HealthHUB® walk-in locations, open seven days a week.
- Virtual primary care options.
That’s only one example, but the Meritain Health creative approach means gaining access to quality health care options tailored to suit today’s employer and employee needs. From in-person and walk-in services to telehealth and mental and behavioral health services, we create unrivaled connections to the right benefits for any situation.
Putting it all together
So, how important is staying in-network versus going out-of-network? Very! But luckily, with strong network options like ones we can offer, that choice is an easy one. As always, if you have questions about what your plan covers, check with your employer and consult your benefits summary.
This article is for informational purposes only and is not meant as medical advice.