In-network
A provider or facility that has a contracted agreement with a patient's health plan to accept a negotiated allowed amount.
Updated
An in-network provider is one that has signed a contract with a health plan to deliver services at a negotiated rate, known as the allowed amount or contracted rate. Patients typically pay less when using in-network providers because the provider agrees not to balance bill for the difference between the charged amount and the allowed amount.
Network participation is plan-specific: a provider may be in-network for one plan but out-of-network for another.
In practice
Eligibility verification checks a provider's network status against the patient's plan before service. In-network claims are paid at the patient's highest benefit level, with the provider writing off the difference between billed charges and the allowed amount per the contract.
Commonly confused with
- Out-of-network: Out-of-network providers have no contract with the plan, resulting in higher patient cost-sharing and potential balance billing.