There\u2019s a lot to know as a consumer of health insurance. When you enroll in a health plan, it can feel like your vocabulary has been upended with words like deductible, out-of-pocket limit, coinsurance, and provider network.\u00a0\u00a0<\/p>\n\n\n\n
Your friends at Blue KC are here to help you understand the terminology and use it to get the most out of your health plan. Today we\u2019ll unravel provider network,<\/strong> because once you know how to navigate it, you\u2019ll save money and gain peace of mind. <\/p>\n\n\n\n What is a provider network? <\/strong>Your Blue KC network is the group of providers and facilities you have access to for your healthcare. It includes primary care physicians, specialty physicians, hospitals, urgent care clinics, labs, x-ray providers, pharmacies, same-day surgery centers, and other healthcare professionals. <\/p>\n\n\n\n What is an in-network provider? <\/strong>When a doctor or other healthcare provider joins a Blue KC network, they are considered in network and have signed a contract to charge lower rates negotiated by Blue KC. Once you\u2019ve met your deductible<\/a>, each time you visit an in-network provider, you will pay only a portion of those lower rates in the form of coinsurance<\/a> or copayment<\/a>. Blue KC will pay the rest. <\/p>\n\n\n\n What is an out-of-network provider? <\/strong>A doctor who has not signed a contract agreeing to Blue KC\u2019s lower, negotiated rates is an out-of-network provider. Depending on the terms of your health plan, out-of-network doctors may only be partially covered by your plan, or not at all. <\/p>\n\n\n\n Even though you may have access to out-of-network providers through your Blue KC plan, you benefit by choosing in-network<\/strong> providers. Here\u2019s why. <\/p>\n\n\n\n You\u2019ll pay less for healthcare in two ways when you use in-network providers. <\/p>\n\n\n\n Here\u2019s how it works: Say your in-network doctor charges a negotiated rate of $200 for an office visit and your coinsurance is 10%. You\u2019ll pay just $20 after you\u2019ve met your deductible. And Blue KC will pay the remaining $180.1<\/sup> By contrast, visit an out-of-network doctor and their rate may be higher plus your out-of-network coinsurance will be higher. <\/p>\n\n\n\n Why it matters? <\/em>This is why you enrolled in health insurance \u2013 to pay less for healthcare. Depending on your plan\u2019s stated coverage, coinsurance may be as low as 10% and copayment as low as $15 for a provider visit once you have met your deductible. <\/p>\n\n\n\nThe Basics<\/strong> <\/h2>\n\n\n\n
Four Reasons In-Network Matters<\/strong> <\/h2>\n\n\n\n
1. Pay less for healthcare<\/strong> <\/h3>\n\n\n\n
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2. Pay a lower deductible<\/h3>\n\n\n\n