Why Does It Cost More To Use Some Doctors?
Physician Networks are about relationships.
If you have health insurance, you have access to what's called a "network."
What is a Network?
A network is a group of hospitals, doctors, labs and other medical professionals who have entered into an agreement with a health coverage provider to deliver quality service at reduced rates to network patients, in exchange for more business. The doctor ends up getting less per patient, but more patients come through the door. Meanwhile, patients pay less for the services they receive.
It's a lot like shopping at a local mom-and-pop hardware store as opposed to a huge national do-it-yourself store. You can go to whichever store you choose, but you'll pay less at the larger store because they do so much more business.
The network system also brings with it a certain level of quality, because in order for a doctor to become part of the network, he or she must be properly credentialed and researched by the state where they practice. Then, in order to stay in the network, they must be recertified every 1 to 3 years.
Just because a doctor is "out of network" doesn't mean you can't use him or her. It just means you may pay more, because that doctor hasn't negotiated the same rates as a network doctor.
If there were no network system in place, doctors could set their own prices on a per-procedure basis. So everyone's costs would go up.
Summary of How Physician Networks Work
Networks mean greater volume for doctors, while patients get greater peace of mind and reduced rates.