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What does in-network or out-of-network mean?

RichDayHealthPlans defines in-network and out-of-network plans:

  • Before we can define in-network and out-of-network, we must first define network provider. 

  • What is a network provider?  A network provider is a middleman that has negotiated rates with hospitals and doctors.  For example, the network provider might say to the doctor:  "If you agree to charge these rates for the following procedures, we will send you thousands of patients." 

  • This is more efficient than having each insurance company negotiate with each doctor and hospital. 

  • NOW, we can define in-network:  If you are in-network, you are dealing with a doctor or hospital that has agreed to work with your network provider, and therefore, your insurance company. 

  • If you go out-of-network, that means that the network provider did not negotiate with your doctor or hospital.  Consequently that doctor and hospital are free to charge much higher rates for their services.
     
  • That is why your out-of-network deductibles and coinsurances are usually double the in-network deductibles and coinsurances.  In some cases, they don't pay anything if you are out-of-network.  You need to confirm that your health care provider is in-network before you avail yourself of their services.

  • In an emergency situation, it is almost always considered in-network, but as soon as you are stabilized, you need to transfer to an in-network health care provider.

You can start by getting quotes

Then, compare the different plans and ask questions. 

Next, apply online! 

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