A health insurance provider network is a group of healthcare providers that have contracted with an HMO, EPO, PPO, or POS plan to provide care at a discount.
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A health insurance provider network is a group of healthcare providers that have contracted with a health insurance plan (via an HMO, EPO, PPO, or POS plan) to provide care at a discount and accept the discounted price as payment in full.
A health plan’s network includes healthcare providers like primary care physicians, specialty physicians, hospitals, urgent care clinics, labs, X-ray facilities, home healthcare companies, hospice, medical equipment providers, infusion centers, chiropractors, podiatrists, and same-day surgery centers.
You will pay lower copays and coinsurance when you get your care from an in-network provider, as compared to when you get your care from an out-of-network provider, and your maximum out-of-pocket costs will be capped at a lower level.
And even the less restrictive PPOs—which do pay for out-of-network care—commonly require you to pay 20% or 30% coinsurance for in-network providers versus 50% or 60% coinsurance for out-of-network providers. And they tend to have higher deductibles and out-of-pocket maximums when you go outside the network. In some cases, they don't limit out-of-pocket costs at all if you see an out-of-network provider (the ACA requires non-grandfathered health plans to limit out-of-pocket costs for essential health benefits, but only in-network; there's no restriction on how high out-of-pocket costs can be if you go outside the network).
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