Verifying if we are within your Network is extremely important. And understanding the difference between In Network and Out of Network Providers can be difficult.
In Network
In Network doctors and dentists contract directly with specific carrier networks and agree to certain guidelines. One key provision is that In Network providers must agree to accept the network’s lower negotiated amounts for procedures that are performed. These lower negotiated rates can typically be 30-50% less than average retail rates for services. In Network providers are also required to file claims to the insurance company on behalf of the member.
Out of Network
Out of Network or Non-Participating Providers on the other hand, have not made any agreements with a particular provider network, and are not bound to the same requirements. Out of Network providers can generally charge market rates for services they perform.
While we are not required to file claims for members, we will file claims as a courtesy to our patients because plans will typically send payments back to the provider for services they have performed. However, Out of Network providers can choose to bill patients the difference between the insurance plan’s payment and the provider’s higher retail charges, which is considered balance billing.”