Verify Providers are In-Network

How to check properly

• Log in to the insurance company website with the username and password you set up. Anthem Blue Cross is at Anthem.com and Blue Shield of California is at BlueShieldca.com.

• Click Find Providers or Find a Doctor, then enter the provider name and your zip code. Logged in, the search is filtered to your actual plan, which is the only fully reliable answer.

• Check labs, imaging centers, surgical centers, and your hospital as well as your doctors. An in network doctor can still send your work to an out of network lab.

• Do not rely on asking the front office whether they take your insurance. A provider can be in network for employer group plans and not for individual plans, and staff rarely know which network a specific plan uses.

• Re-check every year at renewal. Networks change.

What happens if a provider is out of network

You need to use contracted providers to get the low negotiated fees. Outside the protected situations, an out of network provider can bill you their full charge, and that amount goes toward a separate, larger out of network deductible.

• The federal No Surprises Act bars balance billing for emergency care, for air ambulance, and for out of network providers who treat you at an in network facility.

• California adds protections of its own. AB 72 limits what an out of network provider can bill a patient treated at an in network facility under a state regulated plan.

• Outside those situations you are exposed. A single planned out of network surgery can undo years of premium savings.

• If a doctor you cannot replace is only in one carrier's network, tell us. That one fact often decides the whole plan choice.