What’s the Difference Between In-Network and Out-of-Network Care?

January 7, 2025

A senior woman sits up on the exam table at a doctors appointment. She is dressed casually in a blue sweater and has a smile on her face as she glances at the doctor. Her female doctor is wearing a white lab coat and seated in front of her as she takes notes on a tablet.

Understanding the difference between in-network and out-of-network care can save you money and stress. It comes down to whether your insurance company has a contract with a doctor, hospital, or specialist.

Let’s break it down so you can make informed choices and not pay more for healthcare.

In-Network Care

When a doctor, specialist, or healthcare facility is “in-network,” it means they’ve partnered with your health insurance company. Health insurers negotiate with these providers to set agreed-upon rates for care. Think of it as a deal: The provider agrees to rates as a partnership, and you, the patient, benefit from lower costs for services like checkups, lab work, surgeries, and treatments. When you stay in-network, your care costs less because your health plan has already helped lower the price.

Health plans make sure there are enough providers in-network so you can access the care and services you need.

Out-of-Network Care

Out-of-network providers do not have a contract with your insurance company, which means they can charge their full, unnegotiated rate. Since there’s no agreed-upon pricing, your benefit plan might only cover part of the bill—or sometimes none at all—leaving you with higher out-of-pocket costs. But keep in mind that your health plan will cover emergency care with out-of-network providers or facilities as if they were in-network.

Why you should always choose in-network providers

No one wants unexpected, large bills. Choosing in-network care can help you save because your health plan negotiates lower rates. It’s like having a discount already built in.

Choosing a new health plan? Make sure your provider is in-network

Keep seeing the doctors you love! When picking a health plan, confirm your current providers are in-network.

You can do this by:

Checking the provider directory on the health plan’s website.
Calling your provider directly to ask if they accept the insurance plan you are considering.
Contacting the health plan’s customer service to see if your provider is in-network.

For AZ Blue members

AZ Blue has contracted with thousands of doctors to provide in-network quality care for you. Members can log in to their member portal account to search for in-network doctors, healthcare professionals, and facilities. Click ‘Find a Doctor’ on your dashboard to get started!

It’s important to verify in-network care before scheduling:

Confirm with the provider that they are in-network before you make an appointment or schedule another healthcare service.
In-network providers could refer you to out-of-network services like procedures or tests. Always double check!

Do you need more help understanding healthcare? We’ve got you covered! To learn the difference between inpatient and outpatient care, visit: Understanding the Difference Between Inpatient and Outpatient Care.