When you pick a doctor or schedule a procedure, whether that provider is in-network or out-of-network can make a significant difference in what you pay. It is one of the most common sources of surprise medical bills, and one of the easiest to avoid with a little know-how.

Here is what you should know:

1. In-network providers have pre-negotiated rates.  That means lower, more predictable costs for employees.
2. Out-of Network means there is no contract that exists between your insurance and this provider.  Costs are typically much higher and coverage depends on your plan type.
3. Watch for the ripple effect.  If your doctor is out of network, the facility, lab and anesthesiologist may be too, each adding a seperate bill.  Always ask before a procedure, not after.
4. Check your UMR directory by calling Quantum Health at 866-499-5106.  They can tell you if your provider is in tier 1, tier 2 or out of network.
5. Call the provider's office.  Give them your plan name and ask which network they participate in.  Not all plans under the same carrier are the same.
6. Ask about everyone involved.  For procedures, confirm the facility and all providers are in network.
7. In an emergency?  You may be protected from out of network penalty rates depending on your plan.  Check with Jennifer Johnson to verify ER coverage or visit your SPD (summary plan document) found on the Benefits/Wellness tile in your Clever account.

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