Most insurance plans provide covered access to a certain network of providers and locations. There are several advantages to getting care in network:
- You’ll receive a discounted rate
- Your insurance will likely cover more of the total cost of services
- You can expect high-quality care at a fair cost, since your insurance company will have carefully vetted the providers
How do I find a doctor who’s in my network and takes my insurance?
There are several ways to check whether your doctor is in network:
- Go to your insurance company’s website to get an updated network list. If you’re a HealthPartners member, the easiest way to find an in-network provider is through your online account. You can also sign in to HealthPartners mobile app for iOS or HealthPartners mobile app for Android.
- Call your insurance company. Reach out to your plan’s member services team to get help with any questions about your plan. You can usually find their phone number on your health insurance member ID card. If you’re a HealthPartners member, you can see personalized contact options online, or you can call the number on the back of your member ID card.
- Ask your care provider. Your provider may be able to tell you if they take your insurance plan by looking at your health insurance card. But it’s always best to confirm with your insurance plan.
Check often, provider networks can change
Insurance companies routinely review and amend their networks to make sure they remain low cost and high quality. So, it’s a good idea to make sure your doctor is in your network before scheduling an appointment or switching plans. Most insurance companies have a variety of provider networks that pair with different plans. This gives their members more choices so they can find an option with the right combination of premium, out-of-pocket costs and network. It also means that you should determine if your regular doctors are in the network of any plan that you’re considering switching to, even if it’s with the same insurance company or employer.
Use an in-network provider for preventive care services
It’s especially important to see an in-network rather than an out-of-network doctor for preventive care services. This is because preventive services are usually covered 100% by health insurance, but only when you receive care from a doctor or clinic in your network. Preventive care includes your yearly exam, immunizations, health screenings and other certain steps you take to stay healthy.
What if I want to get a cost estimate for my health care?
Most insurance carriers have price transparency tools that can help you estimate what you’ll pay out of pocket, both for in- and out-of-network care. It’s a good idea to check, since providers in the same network can charge different rates for the same services or prescription drugs, and since rates can vary depending on where you get care, like in a doctor’s office versus a hospital. Check with your plan to see what your options and resources are.
Many HealthPartners members can sign in to access our cost estimate tools online. These estimates reflect your specific coverage, so you find the care you’re looking for at a price that’s right for you.
Can doctors look up your insurance?
Yes, doctors can look up your insurance, but it’s best to touch base with your insurance company for questions regarding your specific coverage. Your doctor won’t have the level of knowledge for your plan or network that your insurance company will. Save time, money and potential conflict by getting clarification on your coverage from the experts at your insurance company.
The difference between doctor referrals and insurance referrals
After a primary care visit, your doctor may suggest you get specialized or ongoing care from another provider and provide a doctor – or physician – referral. Having a doctor referral doesn’t necessarily mean your care at the other provider will be covered by your insurance plan. You need to first check if the provider or clinic your doctor recommends is in network. If it is, it will be covered under the appropriate benefit within your plan. If not, you will need an insurance referral.
If needed, your doctor will work with your health plan to submit an insurance referral for your next steps. If approved, this means insurance will cover the cost even though the provider or clinic is not in your network. This can happen in instances where a rare type of care is needed or if your in-network options are too far away. Insurance referrals aren’t always approved, so be sure to confirm before you get your care so you know what is going to be covered.