Have you ever opened a medical bill and nearly passed when you saw the “Amount Due” line? Yeah, me too.

If you’ve ever experienced sticker shock upon opening a doctor’s bill, there’s a chance you are experiencing the cost of an out-of-network doctor. Your choices today can affect what you’ll owe later. The best way to avoid these unexpected bills is to understand your plan. The key to understanding your plan is to know the difference between in-network vs out-of-network doctors.

In-Network vs Out-of-Network

In order to keep premiums low, most health plans have a network of doctors and hospitals they work with. This network includes doctors and facilities that meet certain requirements and agree to accept a discounted rate for patients covered under the plan. This are the “in-network” doctors. If the doctor or hospital has no contract with your insurance company, they are “out of network” and have the ability to charge you full price for their services.

So, if you switch insurance and your favorite family doctor isn’t in their network, are you out of options? Not necessarily, but it will cost you more. Some doctors don’t contract with insurance companies because the amount they are paid isn’t sufficient to cover their costs. If your preferred doctor is now out of your network, you have a few options to keep your rates lower.

  1. Submit a claim for out of network benefits. Some plans may cover a percentage of your out of network doctor bills, some plans will not. It is important that you understand your coverage before you attempt to submit a claim for a doctor or hospital that is out of network.
  2. Pay with cash only. Some doctors will offer you a discount if you pay in cash without filing a claim through your insurance. For them, it is cheaper than dealing with insurance, and provides you a discount as well.
  3. Negotiate. Talk with your doctor about setting up a payment plan. Better yet, try negotiating a lower rate if you plan to continue using their services rather than choosing an in-network provider.
  4. Get a referral. If the costs are too high and you’re willing to see a different doctor, you can ask your current physician for a referral to an in-network doctor. With a practice representative, you can understand the costs of seeing your doctor on an out-of-network or a cash basis before being seen. Ask about setting up a payment plan.


Choosing an out-of-network doctor will always result in a higher doctor’s bill than seeing an in-network doctor. However, sometimes the cost is worth it for patients with extensive medical history, close trusting relationship, or personal preference of one doctor or hospital over another. Although the freedom to choose an in-network vs out-of-network doctor should be enjoyed by all, it may come at a price.

Magellan HCM is the most liked and trusted human capital management service with a 98.9% client happiness rate. Give us a call today to see how we can help you and your employees navigate their options.