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Know Your Provider Network

What is a Provider Network?

A provider network is a list of the health care providers (like doctors, psychologists, and physical therapists) and health care facilities (like hospitals, urgent care clinics, and pharmacies) that a health insurance plan contracts with to provide health care to its members.

These providers are often called “in-network providers.” A provider that has not contracted with your health insurance plan is called an “out-of-network provider” or "non-network provider."

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.

Before you make an appointment for health care or fill a prescription, check to see if the doctor, pharmacy or other provider you want to use is in your health plan's network. To find providers in your network, check your health plan’s on-line provider directory or call the health insurance company’s customer service number.

Keep the following in mind as you use your coverage:

  • Remember that networks can change.
  • Most health plans must cover a set of preventive services at no cost to you. 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 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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