Affordable Care Act
When people purchase health insurance, they’re generally able to visit doctors and other health-care professionals at a negotiated price, determined by their insurance company. The doctors and hospitals that agree to provide care at these negotiated prices are considered “In Network” providers.
Many of the insurance plans that meet Obamacare standards have limited or “narrow” networks of doctors and hospitals who agree to accept these lower negotiated prices. To keep monthly premiums lower, Insurance companies create a list of in-network health providers – doctors and hospitals – that offer services to members of that specific health insurance plan for a more affordable monthly price.
In some instances you may have to go out of your plan’s network to receive care, or you may receive care from an out-of-network provide and simply not know it.
If you find yourself in that position, we have created this video to help you understand Out-of-Network coverage and how it works.
A network health provider has a contractual relationship with a health insurance company. This contractual relationship may establish standards of care, clinical protocols, and allowable charges for specific services.
In return for entering into this kind of relationship with an insurance company, a network health provider typically gains in numbers of patients. A primary care physician may also receive a capitation fee for each patient assigned to his or her care.