What’s the difference between in-network and out-of-network benefits?
Who is this for?
This information will help you if you're shopping for health insurance and have questions about how it works and how your money is spent.
In network or out of network?
The answer to that question could affect how much you pay for your health care services.
If the doctor, hospital or health care facility you visit is part of your insurance company’s network, you'll get your health care at lower prices. But if you go out of your network for health care, it can become a lot more expensive.
Here's an example.
Say you go to a doctor that's in network and the total charge is $250. A discount is applied to that amount for our negotiated rate with the doctor. The discount is $75. Blue Cross Blue Shield of Michigan pays $140. You'll have to pay the remainder, which is $35.
Now let's say you go to a doctor that's out of network. No discount is applied to the total charge. We still pay $140 but you'll be responsible for the remainder, which is $110.
Going out of network could mean you'll have to pay a larger percentage of the cost or the total cost, depending on your particular plan. You may also pay a higher coinsurance percentage and have higher annual coinsurance and out-of-pocket maximums.
To get the most out of your health insurance plan, it’s best to make sure your doctor or hospital is in your network. When you choose one of our plans, you can worry less because Blue Cross Blue Shield of Michigan has the largest network of doctors and hospitals in the state.