Staying In-Network Can Help Cut Costs

When you shop, you probably keep an eye on costs. You want to buy the things you need at a fair price. What about when you’re shopping for health care? Using providers in your health plan’s network can help you save money.

A network includes hospitals, clinics, doctors, pharmacies and others who take part in your health plan. These network providers agree to work with your health plan. That helps keep your costs down. Providers who do not have a contract in place with your health plan are out-of-network.

In-Network, Out-of-Network — What’s the Difference?

By staying in your network, you can take advantage of discounted rates and avoid surprise charges. That’s because in-network health providers and your health plan have agreed to a set price for each treatment or procedure in advance.

A provider who is not in your plan's network can charge higher prices for the same care. You may also have to pay a higher copay or deductible for out-of-network care. In some cases, you may even have to pay the full cost.

Before you go anywhere for care, make sure the provider or facility is in your health plan network. You’ll receive the same quality health care you should expect from any provider at the most affordable cost to you.

Try these tips:

• Once you find a provider, check to see if they are in-network for your specific health plan. Simply asking if they take Blue Cross and Blue Shield insurance is not enough. Give them the information on your member ID card — including the full name of your plan — to make sure.
• If your primary care physician gives you a referral to another doctor, ask for one who is in your plan’s network. Then make sure that the new doctor is in your network.
• If you need surgery or other health services, you'll need to check to make sure each facility where you will get care and each provider who will care for you is in your network.

To find providers in your health plan’s network, log in to your Blue Access for Members^SM account. Select My Health in the top navigation menu, and then click Find Care.

Don’t Forget Pharmacies

When you use a pharmacy that is in your network, you’ll save money. With some prescription drug plans, there can be another consideration. Along with in-network and out-of-network pharmacies, there may be a value pharmacy network in your plan benefits. If so, you’ll save the most money when you fill your prescriptions at value pharmacies.

To find an in-network pharmacy, log in to your BAM^SM account and look under Pharmacy. On the Pharmacy page, click Pharmacy Search.

If you’ve been using a pharmacy that isn’t in-network, it’s easy to switch. You can take your prescription bottle/bag to the new in-network pharmacy. Or you can call the new pharmacy and ask them to contact your current pharmacy. You can also ask your doctor to contact your new pharmacy.

Make sure to ask your doctor to send any new prescriptions to your network pharmacy. You may need to take your BCBSMT member ID card with you if it’s your first visit to the pharmacy or if you’ve changed health insurance plans.

Plan in Advance

Remember, whether it’s a doctor, clinic, hospital, therapist or other provider, you may pay less for care when you visit an in-network provider. That’s why it’s good to learn about your choices before you need care. It will help you be better prepared to take care of your health.

Originally published 10/1/2018; Revised 2022, 2023, 2024