Why in-network care matters: Reducing health care costs for employees and employers
Out-of-network care is one of the quickest ways health care costs increase for both your employees and your business. When employees better understand their health insurance network, how it works and find in-network providers, they’re more likely to avoid higher costs, experience less confusion and use their benefits with confidence.
What is a health insurance network?
A health insurance network is a group of providers and facilities who have an agreement with Wellmark to provide health care services at a lower, in-network rate. Providers outside the network don’t have these agreements. That means costs for services from out-of-network providers are less predictable for your employees and your business — and typically cost more.
Wellmark’s provider network ensures your employees have access to the right care when and where they need it.
Communicate the importance of in-network care
Log in to the Marketing Toolkit to download this ready-to-share email template to help employees learn more about the Wellmark provider network and how to find in-network care.
How out-of-network care impacts health insurance costs, claims and the employee experience
When employees use out-of-network providers, their out-of-pocket costs and claims increase, coverage for services is less predictable and their overall experience with health insurance becomes more complicated. All these factors can influence your total cost of care.
Out-of-network care could increase health insurance costs
Health care services received from in-network providers generally offer the greatest cost savings for employees. Although some health plans provide coverage for out-of-network services, employees may face higher deductibles, coinsurance or other out-of-pocket expenses when they choose providers outside the network. In addition, out-of-network care can contribute to higher and less predictable health plan costs.
The No Surprises Act protects patients from unexpected medical bills when they receive emergency care from an out-of-network provider or facility. The law also established an independent dispute resolution (IDR) process to settle payment disputes between health plans and out-of-network providers.
When these disputes result in higher payments to providers, overall health care spending can increase. In fact, the IDR system has been associated with an estimated $5 billion in additional health care costs over a two-year period. For employers, those added costs can increase health plan expenses. Over time, employees may also feel the impact through higher premiums and other out-of-pocket costs.
Out-of-network care complicates claims
When employees use an out-of-network provider or facility, their claims are impacted too. They may have to fill out more paperwork or manually submit claims on their own.
In-network care provides a simpler health insurance experience
Staying in-network makes the health insurance experience simpler for you and your employees. Employees can better predict what they’ll pay and feel confident their benefits will be applied correctly — reducing confusion and improving benefit utilization over time.
How to help your employees stay in-network
A few helpful reminders can help employees make confident decisions about where to go for care.
- Encourage employees to use myWellmark® when searching for in-network providers and facilities near them. Employees can verify their providers are in-network before receiving care.
- Remind employees to bring their ID card with them to their provider’s office.
- Make sure employees understand that if they choose to see an out-of-network provider or use an out-of-network facility, their costs will likely be more and some services may not be covered.
Wellmark offers free tools and resources in the Wellmark Marketing Toolkit to help your employees understand their network and access in-network care. Log in today to download and share the materials with your employees.