We know that health insurance is a complicated topic and we work hard to try to be informative about health insurance in general and transparent about our specific billing policies. We’ve covered information you should know before purchasing health insurance, but we’re excited to now be in-network with several insurance companies! Since we know that particular confusion can come from terminology about where patients can be seen – ‘in-network,’ ‘out-of-network, ‘insurance accepted,’ and ‘self-pay’, let’s review the differences in the meaning of these particular phrases.
The Meaning of In-Network
Health insurance companies negotiate contracts with certain healthcare providers (facilities and physicians). These contracts specify payments that the healthcare providers will receive from the insurance company for services provided. The providers are, collectively, “the network” for the health insurance, and each individual provider is considered ‘in-network.’ Out-of-pocket expenses are typically lower with in-network providers than out-of-network providers.
The Meaning of Out-Of-Network / Insurance Accepted
Out-of-network simply means that the particular healthcare provider has not negotiated a contract with your health insurance company. Because health insurance companies don’t have a fixed rate for services with out-of-network providers, patients tend to have larger out-of-pocket expenses than with in-network providers. Often, out-of-network providers may use the phrase “insurance accepted.” This means that they will accept your copay or coinsurance for services rendered and file your insurance claim on your behalf. It does not mean that they are in-network with your insurer.
The Meaning of Self-Pay and Out-of-Pocket
In most cases, healthcare providers expect you to have health insurance, either through a large health insurance company, Medicaid, or Medicare. Believe it or not, there are some healthcare providers who prefer to not work with insurance companies at all, or who offer rates for those who do not carry health insurance. Self-pay means that either the healthcare provider will not file a claim and bill insurance on your behalf (meaning you are responsible for the entire cost of service), or that they offer rates for those who do not carry health insurance (and are, therefore, self-paying).
Out-of-pocket can have a slightly different meaning, as it can refer to any cost that you cover yourself, even if you have insurance. Your insurance company or healthcare provider may use this term to refer to any expenses you pay for medical care that aren’t reimbursed by insurance, such as your deductible, co-pay, or coinsurance. You may choose to pay for some services with your healthcare provider out-of-pocket, or you may be required to, until your deductible is met.