Provider Networks

let's talk about provider networks provider networks are made up of the service providers doctors hospitals and healthcare professionals who have a contract with your health insurance policy or plan these providers are known as in-network providers when you use an in-network provider you generally need to pay only your deductible and any applicable copay or coinsurance you will not be billed for the balance by the provider also many preventive services provided by an in-network provider may

be at no cost to you out-of-network providers are those doctors hospitals and other health care professionals that do not have a contract with your carrier you may pay more to use out of network providers than in-network providers if you have a PPO plan and the cost of a covered service is greater than the allowed amount by your healthcare plan you may be responsible for the difference this is called balanced billing in some circumstances an out-of-network provider is not allowed to balance bill for example if you are

treated by a Maryland doctor in an emergency room the law may protect you from balanced billing if your health care plan does not cover out of network providers at all such as an HMO you will be responsible for the entire cost of the services in most cases however if your HMO or other carrier does not have an in-network specialist with training and expertise to treat a condition or disease you may request approval from your carrier to see an out-of-network specialist if your request for a

referral is denied you have the right to appeal that denial and a right to file a complaint with the Maryland insurance administration if you are shopping for a new health insurance policy and you are happy with your current health care providers you may want to consider policies where your current providers participate in network to find an in-network provider you can start with the online provider directory but remember networks can change and the provider database may not be completely up-to-date calling the member service

number on the back of your card can help you verify or find an in-network provider if you have more questions about health insurance find us online at insurance Maryland gov or give us a call at one eight hundred forty six one one six