“Our members are
what we’re here for.

MENASHA, WI (July 14, 2016) 

Health insurance can be a little bit scary. Sometimes it seems like the industry has a language all its own, and you need to be an expert to understand it. Network Health has removed the jargon from health insurance and talks to customers in a language that they can understand. What does it really mean when your physician is in- or out-of-network, and how does that impact your bottom line? Let’s take a look.

In-network providers are doctors that have contracted with your health insurance company to provide medical services at a lower cost to members of your health plan. These contracts help keep the price of your insurance down year after year. Your health insurance company works hard to make sure that you have a variety of experienced and exceptional providers in your network.

Your health insurance company may also offer out-of-network coverage, like Network Health’s Medicare PPO or commercial POS plans. With these types of plans, you’re not limited to only visiting in-network providers. You can also visit out-of-network providers, although it may be for a slightly higher cost. Out-of-network providers are doctors that have not contracted with your insurance company to provide medical services at a lower cost, but if you have out-of-network coverage these doctors are still available for you to see.

Out-of-network providers can be a great benefit to your health care. Having out-of-network coverage allows you the freedom to choose the provider or specialist you want to see. Essentially, you have more control of your health care. For example, let’s look at ThedaCare and Network Health. ThedaCare’s contract with Network Health will end December 31, 2016. That means starting in 2017, ThedaCare providers will be considered out-of-network providers for Network Health members. If you have a Network Health plan with out-of-network coverage, you can still see ThedaCare doctors—you might pay a slightly different cost (often a copayment or coinsurance).

A copayment is a fixed amount that you pay when you receive medical services. Often, a copayment is a small amount, such as $15. You are probably most familiar with the copayment that you pay when you visit your doctor’s office—the office administrator probably requests your copayment amount when you check in for your appointment.

With coinsurance, you are responsible for a certain percentage of the cost of the medical service. For example, some services might be 80 percent covered by your insurance company. The remaining 20 percent is the coinsurance, the amount you pay.

Usually you will pay a smaller copayment or coinsurance amount when you visit providers that are in-network. In the past, high copayment and coinsurance amounts meant that it cost an arm and a leg to visit an out-of-network provider. Now health insurers like Network Health understand that you want to be in control of your health care, and this includes having a wide range of providers to choose from.

Contact your health insurance company to learn more about your in-network and out-of-network coverage.

Visit networkhealth.com or NetworkHealthMedicare.com to learn more about the plans that Network Health has to offer.


Mary Davis, MD
Chief Medical Officer, Network Health

Mary Davis, MD, is the Chief Medical Officer at Network Health. She is a health insurance industry expert in managing high-quality Medicare programs and promoting value-based care through collaborative health plan and provider programs.