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Jan 15, 2014

Did you get a new health insurance plan this year? Have you checked to see if your doctors are “in the network?” More than anytime in the recent past, insurance plans have smaller networks of physicians and hospitals. 

First, a review: what is a network?

In a nutshell, it’s your insurance company’s approved list of doctors. They’ve negotiated lower costs with these doctors - if you use them, you’re considered “In-Network” and your costs are lower, too. Doctors not on your insurance company’s approved list are considered “Out-of-Network.” If you choose one of these doctors, there are no negotiated prices, so you’ll likely pay more. On the other hand, using a provider who’s “In-Network” with your insurance plan will, in most cases, be much less than going to an “Out-of-Network” provider. 

Insurance companies create insurance plans for you to choose from. Some plans have a wide network of providers (physicians & hospitals) for you to choose from (and pay a discounted rate) while others have smaller networks with less to choose from.

Why do networks matter to you? 

We recently wrote an article that showed out-of-network provider charges compared to Medicare payments for 10 common medical procedures. Spoiler alert: charges from out-of-network physicians were a LOT higher!

Why do insurance companies create smaller networks? 

Because they can pay these providers less for your care. With a smaller batch of providers, each provider will have more patients calling for appointments. Physicians agree to charge the insurance company less because your insurance company drives more patients (that’s you) to them. As a result, your insurance premium and medical bills will be lower than if your plan had a larger network.

This is good for the doctors because they’re getting more business, so they’re willing to give a better price – that’s Marketing101. It’s good for your insurance company because they get to pay less to these providers for your care.

Is it good for you? 

That depends! It’s great if your favorite doctor is in the network. It’s great if the surgeon you need is in the network. It’s great if the specialist you’ve been seeing or need to see is in the network. You’ll most likely pay less because of your insurance company’s negotiations. However, if your provider isn’t in the network, that’s a whole different story!

In a follow-up article, we’ll give advice about how to navigate through a shrinking network. What should you look for in an insurance plan for your family? What should you do if you have time to plan a routine procedure?

Now it’s your turn to tell us your story. Has your favorite physician fallen out of your network?  Have you ever needed to see a specific provider that wasn’t in your network?


Heidi has a passion for helping busy families control their healthcare dime, time and peace of mind! She writes articles to do just that, while keeping it fun and simple for her readers! She also speaks on healthcare issues and is the owner of

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Tanya Boyd
Tanya Boyd
President of Tanya Boyd & Associates

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