When it comes to plan and network types, you’re looking at the type of healthcare services that are covered in your plan. As well as the doctors and facilities you are allowed to see. So, what is in-network and how does it apply to you?
In-network means the doctor or facility is contracted by your insurance company. Some plan types let you see any doctor at any healthcare facility. Other plans limit your choices. They can even charge you more to see out-of-network providers. Network status depends on the type of insurance plan.
The different plan types include HMOs, PPOs, POSs, and EPOs. Each plan type has a different amount of freedom in choosing healthcare providers.
Health Maintenance Organizations (HMOs)
HMOs are a type of health insurance plan that only allows you to see doctors within their network. This plan generally doesn’t cover out-of-network services, except in the case of an emergency. An HMO also requires you to choose a primary care physician to be eligible for coverage. The primary care physician coordinates your care. This means they must give you permission before seeing a specialist.
Preferred Provider Organizations (PPOs)
PPOs are a type of health insurance plan that gives you better coverage to see the doctors within their network. You will pay less to see an in-network doctor than an out-of-network doctor. You can still see doctors outside of that plan’s network. Unfortunately, you will have to pay more for those services.
Point Of Service (POSs)
POS plans encourage you to see in-network providers. You will pay less if you use in-network healthcare providers. Think of a POS plan as a hybrid between an HMO and PPO. You are choosing whether you want to use HMO or PPO services each time you go to the doctor. Like an HMO plan, you have to choose a primary care physician. But, you can pay extra to see non-participating providers, as you would with a PPO plan. POS plans also require a referral from your primary care physician to see a specialist for any reason.
Exclusive Provider Organizations (EPOs)
EPOs are plans that only cover in-network services. Unlike an HMO, you don’t need to name a primary care physician or get a referral to see a specialist, as long as you choose a ‘participating provider.’
A network provider has agreed to provide services to the plan’s members at a discounted price.
Contact Our Billing Department
As a courtesy, our Billing Department will verify your insurance benefits. If you do not have in-network medical benefits, please speak with our billing coordinator to discuss self-pay options. There is no payment plan option for self-pay patients.
For more information about our financial policy, click here.