When you need care, it's good to have choices. It could be an emergency, or you may want to see a doctor who's best for you or your family.
If it's a true emergency, you can go to any ER, whether it's in or out of your insurer's network, and the insurer pays the same amount. But if you visit an out-of-network ER, the price may be higher, so you may have to pay the difference between what your insurer pays and how much the ER charges.
When you need to find a primary care physician, pick a network doctor who takes your insurance and is accepting new patients. Do you have kids? You can pick a pediatrician as their primary care doctor.
To see an OB/GYN, you don't need approval from your insurer or a referral from a primary care doctor. Just make sure the OB/GYN takes your insurance and is in your network.*
In the past, some health insurers would pay less when you went to an ER that was not in the insurer's network. Or they made you get approval before getting emergency care at an out-of-network ER.
Now, health insurers can't charge you a higher copay or coinsurance when you go to an out-of-network ER. (However, if you go out of network, the price may be more. You may have to pay the difference between what your insurer pays and how much the ER charges.)
Also, you don't need approval from your insurer before getting care from an ER outside of the network. This is especially important when you're traveling and away from home.
How it impacts you
You have choice when it comes to picking a doctor for you and your family. Whether it's a primary care doctor, OB/GYN or pediatrician, you decide who you want to see in your health plan's network.
Will I have to pay more if I go to an ER that's not in my health plan's network?
Out-of-network hospitals often charge more than in-network ones. You may have to pay the difference between how much the hospital bills for the ER and what your health plan pays.
*Have health insurance under a grandfathered plan? If so, you might not get these benefits. If there is any difference between the information on this website and your health plan, your policy's provisions will apply.