Understanding Insurance: What It Means to be In/Out of Network

Is it always worth it to stay in network?

Health insurance is designed to minimize patients’ health care costs while allowing them to seek and obtain the treatments that they need. Still, bills add up, and getting treatment for a medical condition can be expensive. Understanding your health insurance policy lets you get the most out of your coverage.

Know Your Health Insurance Terms

Most insurance companies have a plan that involves a copay. A copay is a flat fee that you pay every time you see a physician for covered care. Copays are usually involved in regular visits to your family physician, urgent care center or mental health provider. They may also be offered for prescriptions.

You’ll typically pay an additional fee for other types of care, such as inpatient care at a hospital. You’ll also generally be charged a different copay for in-network vs. out-of-network visits.

In Network vs. Out of Network

Many health insurance providers have a network of doctors that have contracted with the insurance companies to be able to provide you with a lower rate for an office visit or copay.

You’ll often be able to visit out-of-network medical professionals, too. However, they don’t have the same discounted agreement with the health insurance company. If you visit a doctor outside the network, you may end up paying more.

In some cases, out-of-network providers aren’t covered at all, and you’ll have to pay out of pocket for the visit. Your health insurance company might cover care with an out-of-network physician, but they could charge a higher copay.

Should You Plan To Stay In Network?

You might think that the best option is to stay within the network. However, there are other variables at play. A health insurance plan with extensive in-network options might have a more expensive premium. You’ll pay more every month, but if you stay within the network, your copay will be lower than if you chose a doctor outside of the network.

If you really love your doctor, you might want to do some homework to find out if he or she is within your health insurance company’s network. If you visit the physician a lot, you might want to choose a plan that includes your doctor in the network.

Sometimes, it’s not possible to see your primary care physician. You might end up making an out-of-network visit and paying the cost because it’s more practical for you. If you don’t go to the doctor very often, you might want to get a health insurance plan with a limited network to save money on monthly premiums.

No matter what you choose, you have many options for high-quality health care. The Urgent Care Association of America says that more than 160 million patients look outside of their primary care physician and visit urgent care centers every year.

Integra Urgent Care offers fast treatment seven days a week. You can even make your appointment and check in online so that you don’t have to wait in the lobby. Integra has locations all over DFW including in Weatherford, Rowlett and more.

We accept a wide variety of insurance options. Call us to find out if we’re included in your network. Even if we’re not, you might find the convenience and quality of care to be well worth the copay.


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