In-Network vs. Out-of-Network Care: What’s the Difference?
In-Network vs. Out-of-Network Care: What's the Difference?
When it comes to health insurance, two phrases can make a big difference in what you pay: in-network and out-of-network. Choosing one over the other can make a world of difference.
So, let’s break it down.
What to know:
- In-network providers have a contract with your insurance company, so you pay lower, pre-negotiated rates.
- Out-of-network providers can charge full price, which often leads to higher out-of-pocket costs.
- AZ Blue members can find in-network doctors anytime through the member portal, and emergency care is always covered as in-network.
What does "in-network" mean?
In-network providers are doctors, specialists, hospitals, and facilities that have a contract with AZ Blue. That contract sets agreed-upon rates for care. Think of it as a built-in discount — AZ Blue negotiates lower prices on your behalf, and you benefit by paying less for everything from checkups and lab work to surgeries and treatments.
When you stay in-network, AZ Blue has already done the work of lowering the price for you.
What does "out-of-network" mean?
If a provider is out-of-network, they don't have a contract with your insurer and can charge their full rate. Without a negotiated price, your insurer may only pay part of the bill — or sometimes none of it — so you could be billed for the difference (known as balance billing). That can add up quickly for surgeries, specialist visits, or hospital stays.
Out-of-network care isn't always wrong, but it should be a planned choice, not a surprise.
Emergency exception: True emergency treatment is always covered as in-network by AZ Blue, even if the hospital or provider is out-of-network. In an emergency, go to the closest hospital. Before you book non-urgent care, check a provider's status in your AZ Blue member portal or call AZ Blue member services to avoid unexpected costs. To learn more, see: What Does a Covered Healthcare Service Mean?
Why in-network care saves you money
When you stay in-network, AZ Blue has already cut a deal on your behalf. You pay less, and you avoid the kind of unexpected bills that can throw off your whole budget.
How to check if your doctor is in-network
If you're picking a new plan or want to verify a current provider, there are three easy ways to confirm:
- Check the AZ Blue provider directory — search by doctor name, specialty, or location in your member portal.
- Call your provider's office directly and ask if they accept your plan.
- Call AZ Blue member services and ask them to confirm.
It only takes a few minutes and can save you hundreds — or even thousands — of dollars.
Know your in-network options before you need them
Life happens. Accidents, sudden illnesses, and middle-of-the-night ER visits don't give you time to research. Taking a few minutes now to look up your in-network options can save you real stress and money later.
- Make a short list of in-network hospitals and urgent care centers near your home and workplace.
- Save it somewhere easy to find — a note on your phone or a magnet on the fridge.
- Share the list with family members so everyone knows where to go.
Remember: emergency care is always covered as in-network by AZ Blue, even if the hospital isn't. But for non-emergency hospital stays, urgent care visits, planned procedures, or follow-up care, knowing your in-network options ahead of time makes a big difference.
Do you need more help understanding healthcare? We’ve got you covered! To learn the difference between inpatient and outpatient care, visit: Understanding the Difference Between Inpatient and Outpatient Care.