Staying in-network: understanding individual and family plans
When considering an individual or family plan, it’s important to understand how your health plan network impacts your costs and options for care. Staying in the Wellmark provider network for care makes it easier to access providers, reliably estimate your costs and avoid surprise bills. The simple act of checking that your providers are in-network before receiving care is one of the easiest ways to manage your costs. Here’s how your individual or family plan uses Wellmark’s network and how to use myWellmark® to check if a provider is in-network before you get care.
The difference between in-network vs. out-of-network care
A health insurance network is a group of doctors, specialists, facilities and other medical providers who have an agreement with Wellmark to provide health care services at an in-network rate. This saves you money and is part of your health plan's benefit design to offer lower copays and have fewer out-of-pocket costs when you stay in-network for care.
Out-of-network providers do not offer in-network rates, which means you will likely pay more for a service. If you want to see an out-of-network provider, your plan might not cover services from than provider and your costs will likely be more than if you went to an in-network provider. Switching to an in-network provider can help you avoid these extra costs and give you a more reliable idea of what you’ll pay for a service.
Wellmark’s provider network is broad and offers a full range of specialties across Iowa and South Dakota, so our members can get the care they need, when they need it.
Easily manage your individual or family health plan
With myWellmark, you can browse in-network providers, track your claims and get cost estimates for care. Log in or register to get started.
Why out-of-network care costs more
Here are a few reasons why you pay more when you receive care out-of-network:
- Out-of-network health care providers do not contract with Wellmark and, as a result, can’t offer a discounted rate.
- You may have to pay coinsurance, a percentage of the total covered charges, instead of a copay. This can cost much more depending on the services you receive.
- Many plans have a maximum amount they will reimburse for out-of-network services. You may have to pay the difference between this amount and the total cost.
How we work to save you money on quality care
Wellmark works hard to maintain agreements with providers so we can keep health coverage and out-of-pocket costs low. We advocate for our members by regularly evaluating reimbursement rates with in-network providers to ensure affordable, high-quality health care.
How to find in-network care near you
Staying in-network is key to getting the most out of your health plan and being able to reliably estimate your health costs. Use these resources to check if your providers are in the Wellmark provider network and avoid surprise bills.
Before enrolling in an individual or family plan, you’ll want to check to see if your current providers are in-network. If they aren’t, you’ll need to switch to an in-network provider once you enroll or pay more to continue seeing them.
If you’re already a Wellmark member, log in to myWellmark to browse in-network providers and find detailed claims information in myWellmark. Or call customer service at 800-524-9242 (TTY: 888-781-4262), Monday-Friday, 7:30 a.m. to 5 p.m. (Central Time) and be ready with your Wellmark insurance card.
Considering a Wellmark individual or family plan?
With a Wellmark individual or family plan, you get access to a broad network of providers and support from an insurer with more than 85 years of experience. Learn more about these plans, see what options are available in your area and compare individual and family plans side by side.