Tips for Finding an In-network Doctor

Just about every hour I get asked "Does Dr. So-and-so accept my insurance?"

It sounds simple, and it is. But, whether or not your medical provider is "in-network" (which means they accept your plan) could be the difference between having affordable coverage and burning money out of your pocket.

What Is an In-Network Doctor?

An in-network doctor is a provider who has a contract with your insurance company. They’ve agreed to bill your insurance carrier directly and apply discounts negotiated by your insurance carrier.

Some plans are PPO plans (Preferred Provider Organizations) which allow you to see providers both in and out of network. Typically, you pay more to see out-of-network providers compared to in-network.

Other plans are HMO plans (Health Maintenance Organizations). HMOs will never cover out-of-network services which makes it even more important to find a doctor that accepts your plan.

Using in-network providers saves you money and offers you a better experience. That usually means:

• You pay the lower, in-network cost.

• The billing process is smoother.

• There’s less chance of surprise charges.

If a doctor is out of network, they don’t have that agreement. Depending on your plan, that could mean higher costs — or sometimes no coverage at all (except in emergencies).

How to Check If a Doctor Is In Network

You have multiple options.

1) Check your insurance plan's directory. You can find this directory on your insurance plan's website or mobile app. Try googling "<Insurance company name> find a doctor".

If you have an online account, this process is even easier. Simply log in and look for the option to "find a provider" or something similar. You can also get a printed version of your plan's provider directory by calling customer service.

*Make sure you are looking at the directory for your exact plan as a provider may not be in-network with every plan an insurance carrier offers.

2. Call the Member Services number on your ID card. They have access to additional tools and the most up to date information.

3. Call the doctor’s office directly. Be sure to tell them your exact plan name.

What if I can't verify my doctor is in-network?

Well this is annoying. Medical groups and hospitals are constantly hiring and shifting staff around which causes these directories to be out of date or inaccurate at times. Sometimes you have to take your best guess. Luckily, I've gotten pretty good at this, so if you find yourself uncertain please give me a call.

By following these steps, you can efficiently find an in-network doctor who meets your healthcare needs while minimizing your out-of-pocket expenses.