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Know Your Provider Network

Provider Networks

In-network provider:  A health care provider (like doctors, psychologists and physical therapists) or facility (like hospitals, clinics and pharmacies) that an insurance company contracts with to provide services to its members.

Out-of-network provider: A health care provider or facility that has not contracted with an insurance company.

The Importance of Staying In-Network

Using providers in your health plan’s network will likely keep your health care costs lower. If you use an out-of-network provider, you likely will pay more for those services except in an emergency.

Before you make an appointment for health care or fill a prescription, check to see if the provider is in your health plan's network. To confirm a provider is in your network, contact your health insurance company.

Keep the following in mind as you use your coverage:

  • Health plan networks can change.
  • Most health plans must cover a set of preventive services at no cost to you, if you use an in-network provider. These services are free only when delivered by a doctor or other provider in your plan's network.
  • How different plan types—HMO, PPO, EOP and POS—work with provider networks can vary significantly. For example, to see a specialist (like an orthopedist), some plans require a referral from your primary care doctor. Read more about plan types.
  • In a hospital, it’s possible that not all the providers treating you will be in-network. For instance, your surgeon could be in-network, but your anesthesiologist could be out-of-network.
  • Contact your health insurance company if you have any benefit or provider network questions.

See the insurance companies offering plans through MNsure and their provider networks.

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