How Do You Know if Your Insurance is in Network?

May 11 2021
Understand your insurance plan

All Insurance Plans Are Not Equal

It is important to understand that all plans provided by insurance companies are not the same, your plan will provide the coverage you’ve agreed to pay for. Think of it like buying a car. You want to buy a Subaru Outback, but you only want the basics, that car will come with a basic price. But what if you are willing to buy a Subaru Outback Limited with 10-way power driver’s seat, all-weather package including heated seats, leather-trimmed upholstery and the 12-speaker, 576-watt-equivalent Harman Kardon premium audio system – it is going to come at a premium price. While you and a friend may have the same insurance company, there is a very high probability that your actual plans are not the same and do not cover the same services at the same levels.

Contact Your Insurance Company to Understand Your Benefits

Your best option to learn exactly what is covered in your plan is call your insurance company or log into your insurance company’s website. You will be asked to put in the provider or hospital (National Provider Identification) NPI number to see what is in network and covered. You can find your provider’s NPI number at npiregistry.cms.hhs.gov. Please note that your insurance card does not tell our registration team if your insurance is in network with our facility and services. It is very important to understand that your insurance coverage is an agreement between you and your insurance company relating to your coverage, not an agreement between the insurance company and the healthcare organization.

Learn More About Insurance Benefits and an Emergency Department Visit

One area that is very important for you to understand is an emergency department visit. The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay. We must adhere to the EMTALA law, making it unlawful to discuss insurance prior to being triaged or screened. It is also important to note that many insurance companies are taking a critical look at emergency department visits. If your insurance company determines that an emergency department visit could have been handled in a Primary Care office or in an Urgent Care Center, your claim could be denied, and you would be responsible for the cost of services.

If you have any additional questions, please visit our Billing & Financial Services page.