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Understanding The Difference Between In-Network and Out-Of-Network Provider Coverage


A lot of things can happen to put you in the market for a new doctor. Maybe you’ve moved to a new town and need to find a pediatrician for your kids’ well-visits. Or your primary care physician (PCP) recommends you follow-up with a specialist. Or you’ve turned 45 and are due to get your first colonoscopy. Whatever the reason, you want to be sure you’re choosing the right doctor.

All health insurance plans have a network of doctors, and selecting one who is in that network can save you money. In fact, some plan types require you to see an in-network provider. So, how do you find a provider who’s in your health plan’s network?

Recommendations from friends, family, and your PCP are a great place to start. Your next stop should be our Find a Doctor tool, which makes it easy to find in-network doctors and other health care providers, such as labs, hospitals, urgent care centers, and outpatient surgery centers. Review the questions and answers below to help you understand the difference between in-network and out-of-network and how to choose a doctor.

What is a provider?

A health care provider is a person or company that delivers a health care service to you. Types of providers include your primary care physician (PCP), specialists, and even facilities, like labs, hospitals, and urgent care centers.



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