What is a Provider Network?
A provider network is a list of providers and hospitals/facilities a health insurance company (for us, it’s Blue Cross Blue Shield) contracts with to provide healthcare services to its members at a discounted cost. That discounted cost is passed to members (you and your covered dependents), who benefit from lower out-of-pocket costs (copays, deductibles and coinsurance) – plus a lower annual out-of-pocket maximum.
On the other hand, you will pay more to use providers and facilities that are not on the list. Those providers are out-of-network and when you use them, you will receive no discount and pay higher out-of-pocket costs.
Bottom line: It pays to use providers in our medical plan’s preferred networks whenever possible.
Two parts of a network: Providers and facilities
Each medical plan network has two elements that charge fees for healthcare – the people who provide the care and the place where care is received.
- People = provider: The physician, advanced practice provider or other clinician who is providing the service.
- Place = facility: The location where you are receiving the service. This may be a physician office, urgent care, emergency room, hospital, etc.
It’s important to understand that sometimes a provider may be in-network, but the facility is out-of-network. Or the opposite may be true.
Before you visit a provider, be sure to confirm both they and the location where you are seeing them are in-network. If not, it’s OK to proceed with the visit as long as you understand you’ll pay higher out-of-pocket costs for the provider and/or facility fees.
The 3 provider networks in our medical plans
The health system offers the same three provider networks for both medical plans – the HSA Advantage Plan and the Signature Plan:
- Health system network – this will always be your lowest cost
- In-network (BlueSelect Plus in KC; BlueCard PPO outside KC and nationwide)
- Out-of-network – this will always be the highest cost
Read Find a Provider to learn how to check which network your current providers are in and how to find new providers in your desired network.