Health Insurance

Is My Doctor Covered by My Insurance?

When your health plan changes either by yourself or your employer, it’s important to check whether your current doctor is still covered by your health insurance.

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When your health plan changes either by yourself or your employer, it’s important to check whether your current primary care doctor is covered by your new policy. In doing so, you could make sure that you’re paying for lower healthcare costs when your provider is in-network.

What Does In-Network Mean?

A doctor network, also known as a provider network, is when a hospital, doctor, or other healthcare provider is in a contract with a health insurance company to provide care for its members.

In doing so, the providers have agreed to not charge you more than what was agreed upon with your insurance company. This allows you, the insured, to have lower healthcare costs when you go to a doctor that’s in-network.

By law, insurance companies must cover certain preventative care services at no cost to you. Preventive care services include, but are not limited to:

  • Annual check-ups
  • Flu shots
  • Mammograms
  • Colonoscopy screenings

In-network vs. Out-of-network

One of the biggest differences between an in-network provider compared to an out-of-network provider is the cost. Since your in-network provider is contracted with your insurance company, you may pay for your service at a discounted price.

If a doctor, hospital, or other healthcare provider doesn’t take your health plan, they’re considered out-of-network. You may find yourself paying for the majority of your out-of-network services or even the entire amount. Going out-of-network could impact your costs, as your insurance company may not help cover your bills.

Depending on the insurer, some out-of-network services could be covered in the case of an emergency visit or if you need medical care while traveling.

Can I Keep My Primary Care Doctor if I Switch Insurance Policies?

When switching to a new health insurance policy, you may be allowed to keep your primary care doctor if your doctor is in-network. If your primary care doctor is out-of-network, you may have to pay out of pocket to see them or change to a different primary care doctor.

There could also be decisions outside of your control that may force you to change your primary care doctor. For example, your health insurance company may choose to not cover your geographic area anymore. Or, your employer who provides you with health coverage decides to go with a different health insurance company.

If you’re unsure if your current doctor is covered under your new plan, you can check via the following methods:

Call Provider Office

You may call your health provider’s office to verify if your provider is covered by your insurance company. If your provider is not covered by your health insurance company anymore, you may choose to have your doctor recommend and refer you to someone that is in-network.

Call Insurance Company

You may call your health insurance company to verify if your current primary care doctor is in-network. In the case that your doctor is not in-network, the insurance company may provide you with different healthcare providers that you could switch to.

Check Online Resources

The best online resource to check if your current doctor is in your new network is by looking at their direct website. Most healthcare providers provide a list of networks that they work with. Bear in mind that some websites may be outdated. If so, you may call your provider’s office to verify.

How To Find a Doctor in My Insurance Network

You may find a doctor in your insurance network by inquiring online or over the phone with your insurance company.

Online

Insurance companies may post in-network providers on their websites. When looking on your health insurance company’s website, make sure that you’re comparing networks to your policy. Healthcare providers such as hospitals may list health insurance companies that they work with on their websites as well.

Bear in mind that the list from both the insurance company and healthcare provider may be outdated. If you’re unsure, you may call to verify.

Over the phone

If you want to verify if a doctor is in your insurance network, calling your health insurance company could be one of the best ways to do so. When calling your insurance company, you may need your policy number and plan information, which may be found on your insurance card.