What’s the Difference between IN-Network and Out-OF-Network?

Typically in network refers to a Doctor or office who has a set contract with an insurance plan to either sell services or materials at a specific costs to members or give a certain discount off materials. Generally the insurance may pay a portion of the discount but the office usually is writing off a chunk of that sale in favor of getting more customers from that insurance plan. Out-Of-Network refers to a plan that no previous contract has been made. Some insurance plans allow you to go to any doctor and then will reimburse you either the same amount or a little bit less then they would an In-Network doctor for the same services or materials. Generally it is better to go In-Network, but there are some cases in which going out-of network can save you more money in the long run. How?

Lets say John’s glasses at his In-Network doctor come out to $500. With his insurance plan he gets $250 off, so he ends up spending $250 out of pocket and the insurance probably pays the doctor $150. Now John goes to another office (out of network) and his same glasses come to the same price, $500. But they are having a 30% off sale which they can’t combine with any insurances that they take, and John ends up paying $350 in the store for his glasses. He submits an out of network claim to his insurance and they pay him the $150 that they would have normally given to his doctor. When john gets his check form the insurance now he has only spent $200 for his glasses, saving himself $50 by going out of network. Many insurance companies, like VSP, generally allow their members to go out of network and will tell them exactly what kind of reimbursement to expect. So do your HOMEWORK!

If we are out of network for your insurance we will be happy to call you insurance for you and find out what kind of reimbursement they have available to you and get information on how to file a claim.

Justin is a ABO certified licensed spectacle dispenser (California’s equivalent to Licensed Optician). He has been in the optical industry for 8 years in different states and currently manages Optometry by Thanh-Vi Nguyen in La Quinta, CA.

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2 thoughts on “What’s the Difference between IN-Network and Out-OF-Network?

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