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Network Provider

What is a network provider?

A network provider, also known as an in-network provider, is a healthcare provider or healthcare facility contracted to provide healthcare services to the members of an insurance plan. Network providers can include facilities such as pharmacies, hospitals and urgent care clinics, and professionals such as psychologists, physical therapists, and physicians.

Network providers provide healthcare services for insured patients under their plan for free or at a cheaper cost than out-of-network providers. In exchange for providing healthcare services at a reduced fee, network providers receive a higher volume of patients from the insurers they are contracted to. Providers who are not included in an insurance plan are called out-of-network providers.

Network providers can fall under different plans.

  • Health Maintenance Organizations (HMOs) limit patients’ coverage to the providers who are members of the HMO, or whom they contract to provide care.
  • Exclusive Provider Organizations (EPOs) only cover patients who use the healthcare providers and facilities within their network.
  • Point of Service Plans (POS) charge patients less if they use healthcare facilities and providers within their network. They also require patients to obtain referrals from their primary care provider for specialist care.
  • Preferred Provider Organizations (PPOs) charge patients less for using providers in their network but will allow for use out-of-network providers for an additional cost.

What role do network providers play in healthcare?

Network providers are important because they are the patient’s first port of call for medical visits and routine diagnostic tests such as physicals.

Through network providers, insured patients can access quality healthcare without having to spend so much money out of pocket.