Will choosing a doctor within my insurer's network save me money?

Choosing a doctor within your insurer's network usually will cost you less money than choosing a doctor who is out of the network. Just how great those differences are may depend on the specifications of your health plan.

For example, if you choose a health maintenance organization (HMO) plan, your care will be coordinated by a primary care doctor whom you select within that HMO's provider network. If you need to see a specialist, that primary care doctor will need to write you a referral to a specialist within that network. If you need to see a doctor outside of your network without your doctor's referral, you will likely need to pay more -- even possibly the full cost of your care from that out-of-network doctor.  (Emergency uses may get some coverage regardless.) Exclusive provider organization (EPO) plans work much the same way as HMOs.

If you have a preferred provider organization (PPO) plan you may be able to see any provider you would like, in or out of that PPO's network, but your copays and other out-of-pocket costs will be higher if the doctors you see are outside of the PPO's network.  Point of service (POS) plans are similar to PPOs in this regard.

Doctors who contract with certain insurance companies to be part of that company's network of providers usually agree to accept lower payments when coverage is provided by that plan. Those lower costs are passed down to you, the patient.

Consider the network of providers carefully when you are deciding which health plan to choose to be sure you will be able to find qualified doctors near you who will accept your insurance coverage. 

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.