RichDayHealthPlans defines in-network and out-of-network plans:
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Before we can define in-network and out-of-network, we must first define network provider.
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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."
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This is more efficient than having each insurance company negotiate with each doctor and hospital.
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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.
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Then, compare the different plans and ask questions.
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