What Does “In-Network” Mean?

Sometimes the words used in health care can be confusing. Making sure you know what "in-network" means may also mean you might save money. Listen in on this discussion between our health advocate and Victor, a BCBNM member.

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VICTOR: I'm Victor, and I'm meeting with a Blue Cross and Blue Shield customer advocate to discuss what in-network means. I've heard the term in-network before, but I don't understand it. What does it mean?

BCBS ADVOCATE: Good question. In-network or provider network are important terms to be aware of when learning about your health plan coverage. This knowledge can also help you avoid unexpected out-of-pocket costs.

VICTOR: OK, good to know, but what does in-network mean?

BCBS ADVOCATE: So a health plan is made up of doctors and other health care professionals, or providers. Those providers who are considered to be in-network have agreements with Blue Cross and Blue Shield.These agreements include billing for services at our allowed amount and not billing the members for the difference. They are also required to follow contractual requirements that ensure that Blue Cross and Blue Shield numbers are receiving the best possible care.

VICTOR: Oh, so I can save money by seeing a doctor that's in-network.

BCBS ADVOCATE: Your costs will be determined by your plan's coverage. But if you visit a doctor outside of your network, you may have to pay more for your care. In some cases, you may have to pay the full cost.

VICTOR: Is it difficult to find doctors that are considered in-network by my plan?

BCBS ADVOCATE: Not at all. We offer a convenient tool called Provider Finder to find in-network doctors and hospitals to help you. You can find it on our homepage under the Find a Doctor or Hospital tab. You can also find in-network here on the mobile app. It's listed at the bottom of your mobile app dashboard.

VICTOR: OK. Thank you for your help.

BCBS ADVOCATE: You're welcome.

NARRATOR: For more information, call the number on your member ID card, or visit our website site at BCBSNM.com

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