It Pays to Stay In-Network When You Can
When you stay in-network…
Get charged less
Healthcare providers can’t bill you more than the allowed amount we negotiated with them.
Lower deductible
You usually benefit from a lower deductible based on your in-network benefits.
When you go out-of-network…
Get charged more
You can get billed for the difference between the allowed amount and the provider’s charge.
Higher deductible
Your out-of-network benefits typically have a higher deductible before your plan pays.
In-Network vs. Out-of-Network Comparison
| Same service | In-network provider | Out-of-network provider |
|---|---|---|
| Provider charge | $1,000 | $1,000 |
| Amount negotiated on your behalf | $600 | $600 |
| Plan pays | $480 | $480 |
| Your coinsurance | $120 | $120 |
| Balance bill | $0 | $400 |
| Total you pay | $120 | $520 |
How to Protect Yourself
Know Your Benefits
Understand what services are covered under your AZ Blue plan benefits.Choose In-Network Providers
Always check that your provider is in your plan's network before getting care. You can do this by using our Find a Doctor Tool.Review All Bills Carefully
Compare your bills to your Explanation of Benefits (EOB) to make sure you're not being wrongly charged.
Submit a claims review form to ensure your claim gets processed correctly.
Your Protections Under Federal Law
The No Surprises Act protects you from surprise balance billing in certain situations:
Emergency Services
If you have a medical emergency, you can only be charged your plan's normal in-network costs (like copays), even if the doctor or hospital is out-of-network. You cannot be charged the difference between what the hospital bills and what your insurance pays. This also covers care after you're stable, unless you sign a consent form agreeing to give up that protection.
Certain services at an in-network hospital or ambulatory surgical center
If you get services from an in-network hospital or surgery center, certain providers there may be out-of-network. These providers can't balance bill you unless you give written consent ahead of time.