February 29, 2024

Navigating the complexities of health care can be overwhelming, especially when it comes to understanding your insurance coverage. One question that is consistently raised — how do I find in-network providers?

Knowing which providers and facilities your plan considers to be “in-network” is crucial to ensure you receive appropriate coverage while minimizing out-of-pocket costs. So, this guide will provide a basic overview of why in-network providers matter, and then walk through the basic steps of finding in-network providers with an Anthem or United Health Care plan — two of the most common insurance providers in the region.

Why In-Network Matters:

Choosing in-network providers offers several advantages:

Reduced Costs:

In-network providers have negotiated discounted rates with your insurance company.  And choosing them typically translates to lower co-pays, deductibles, and out-of-pocket expenses compared to out-of-network providers.

Typically plans cover 50% or less of procedures conducted out of network. And for some plans there is zero coverage. It is important to check and understand your Summary of Benefits and Coverages (SBC) document for a full understanding of this cost-sharing breakdown.

Simplified Claim processing and submission

In-network providers are contracted with your insurance company to submit claims on your behalf. This means less work for you after a doctor’s visit — and less opportunity for errors and delays.

Because in-network providers submit claims through the insurer’s preferred channels, the claims are received and processed much faster than self-submission. Out-of-network claims may be delayed due to the mail, missing information or follow up with the provider.

Starting your in-network provider search

The most accurate way to find in-network providers starts with creating an account on your specific insurance provider’s website. Furthermore, this personalized approach bypasses potential inaccuracies associated with general search queries and provides you with results directly related to your unique plan details.

Searching for in-network providers with Anthem

  1. Head to Anthem’s
  2. Locate the prominent green “Find Care” button in the top right corner and click it.
  3. Choose the option “Basic Search as a guest” to proceed without logging in.
  4. Select the plan type you need a provider for (Medical, Dental, or Vision).
  5. Next, indicate the state where your plan or network is offered.
  6. Specify how you obtain your insurance. For our clients, it’s typically “Medical (Employer-Sponsored).”
  7. Finally, choose your specific plan or network. If you’re unsure, check your ID card or reach out to your HR department for clarification.

Alternatively, explore the Sydney App:

  1. Download and install the Sydney App on your preferred device or access it through your computer.
  2. Log in and search for in-network providers within your Anthem plan.

Searching for in-network providers with United Health Care

  1. Visit UHC’s website to begin your in-network provider search.
  2. Click on “Find a Doctor” located conveniently in the top right corner.
  3. Choose the “Guest Provider Search” option to proceed without logging in.
  4. Select the type of provider you’re seeking (Medical, Behavioral Health, Dental, or Vision).
  5. Next, indicate your plan type. For our clients, it’s typically “Employer or Individual Plans.”
  6. Specify if you’re currently a UHC member.
  7. If you’re a current member:
    • Create an account or log in to access personalized results tailored specifically to your plan details.
  8. If you’re not a current member:
    • Choose your general UHC plan to view estimated covered providers.
  9. Utilize the platform to browse specific providers and hospitals in your area.
  10. Search for providers based on treatments or conditions you might be interested in.

Remember, When in Doubt, Reach Out:

If you are ever unsure if your provider is in-network, don’t hesitate to contact your insurance company’s member services directly. The phone number is usually located on the back of your insurance ID card. Their representatives are equipped to verify a provider’s network status based on your specific plan details, ensuring you make informed healthcare decisions.

Next time you find yourself wondering — “is my provider in-network?” — navigate your search with ease and make a decision that prioritizes your health AND your wallet.

 

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