What is In-Network? Everything You Need to Know About Health Insurance Providers

In-network refers to healthcare providers or facilities that have a contractual agreement with your health insurance plan. This means they've negotiated discounted rates for their services, which translates to lower out-of-pocket costs for you, the insured individual.

In this guide, you'll learn:

  • How in-network providers benefit you
  • How to find in-network providers
  • What happens if you go out-of-network
  • Tips for maximizing your health insurance benefits

Table of Content

A blue circle overlapping a white circle, representing the concept of in-network healthcare providers and their relationship with insurance companies.

Key Takeaways:

  • In-network providers have agreed to discounted rates with your insurance, lowering your out-of-pocket costs.
  • Use your insurer's directory or call them to find in-network doctors and facilities.
  • Going out-of-network can lead to significantly higher expenses.
  • Always confirm a provider's in-network status before receiving care to avoid surprise bills.

Why Choose In-Network Providers?

The primary reason is cost savings. In-network providers have agreed to specific rates with your insurance company. This means you'll typically pay less for doctor visits, hospital stays, procedures, and medications. Plus, your insurer will often cover a higher percentage of the cost when you stay in-network.

  • Lower copays and coinsurance: These are the fixed amounts or percentages you pay for covered services.
  • No surprise bills: In-network providers can't bill you for more than the agreed-upon rates (except for allowed copayments and deductibles).

For those concerned about cost, our licensed insurance agency can help find insurance options to lower the cost or to cover the procedure.

How to Find In-Network Providers

Your insurance company should provide an online directory or search tool to help you find in-network doctors, hospitals, and specialists. You can also call the customer service number on your insurance card.

If seeking a licensed professional, consider our services. Our insurance advisors and client support team are here to assist you with your insurance needs.

What Happens If You Go Out-of-Network?

While you can usually see any provider you choose, going out-of-network means you'll likely pay significantly more. Your insurance might cover less of the cost, and you could be responsible for the full amount charged by the provider.

Exceptions: In emergencies or for certain specialized care, your insurance might still cover a portion of out-of-network costs. It's essential to check your policy or contact your insurance company to understand your coverage.

Tips for Maximizing In-Network Benefits

  • Always confirm: Before any appointment or procedure, double-check that the provider is in-network to avoid unexpected costs.
  • Get referrals: For specialist visits, check if your plan requires a referral from your primary care physician.
  • Review your Explanation of Benefits (EOB): This document shows how your insurance covered the cost of your care. Review it for accuracy and to ensure you're not being overcharged.


Understanding what "in-network" means is crucial for getting the most out of your health insurance and saving money. By choosing in-network providers whenever possible, you can take advantage of lower costs and better coverage.

For more insight into how this concept interacts with others, see our detailed guide on [Deductibles and Coinsurance], which further explores how these costs work with in-network and out-of-network care.

In-Network FAQ

Does using an out-of-network doctor mean I have no coverage?

Not always. Even with out-of-network providers, your insurance may still cover a portion of the costs, especially in emergencies or for certain specialized care. It's crucial to review your policy details to understand your out-of-network benefits.

Can I change my health insurance plan to include my current doctor?

You can switch plans during open enrollment or if you have a qualifying life event. However, not all plans include the same providers. Research and compare plans to find one that includes your preferred doctor in their network.

What if my preferred doctor leaves my insurance network?

If your doctor leaves your network, you have a few options. You can switch to a new in-network provider, continue seeing your doctor and pay the higher out-of-network costs, or explore switching to a different insurance plan where your doctor is in-network.