How using in‑network providers helps lower your costs

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Did you know that choosing and using in-network providers can help you manage your out-of-pocket costs? Here’s how you can make sure the providers you see are in-network and reap the benefits of the Wellmark provider network.

In‑network vs. out‑of‑network providers: what’s the difference?

A network is a group of doctors, specialists, facilities and other medical providers who have an agreement with Wellmark to provide health care services to our members at an in-network rate. An out-of-network provider does not offer those same rates, which means you’ll pay more for your care.

While it’s best to use in-network providers, there may be rare situations where there isn’t one available. In some cases — like emergency situations — you may be protected from surprise bills or balance billing under the No Surprises Act (NSA).

If you aren’t in a situation protected by the NSA and a provider or facility is out-of-network, ask the provider if you will be billed for the difference between what Wellmark covers and the full charge for the service. If the answer is no, make sure to get it in writing. If the answer is yes, understand that you’ll be responsible for the out-of-network costs associated with receiving care from an out-of-network provider. These costs will vary depending on your specific plan, but out-of-network care often means paying more out-of-pocket.

Why asking “Do you take Wellmark?” isn’t enough

It’s a common question, but the answer is not always that simple. A provider may belong to the Wellmark network but still not be covered by your specific plan. That’s why it’s so important for you to know how to check if a provider is in-network for your specific plan.

How to check if a provider is in-network

Here are a few ways to check:

Log in to myWellmark.

The fastest and most convenient way to check if a provider is in network is to use myWellmark. Once you log in, you can search for providers by name, specialty or facility.

Check with your provider’s office.

You can check directly with your provider — just be sure to reference your member ID card for your exact plan name. This can be found on the upper right corner of your physical card or on your digital ID card in myWellmark.

Call for help if you need it.

Call BeWell 24/7^® Nurse Support anytime, day or night, to get help finding in-network care near you. BeWell 24/7 is especially helpful when you are traveling. Call the number listed on the back of your Wellmark ID card.

How to lower your health care costs with in-network care

Depending on your plan, if you don’t see a provider or use a facility in your health plan’s provider network, your services may not be covered. This results in missing out on in-network savings and potentially having to pay more out-of-pocket. And, some health plans don’t have out-of-network benefits other than in emergency situations, so it's important to check that your providers are in-network and understand your benefits before you seek care.

The best way to get to know your plan and in-network provider options before you get care is by registering for a myWellmark account. Once registered, myWellmark gives you personalized health care information, so you can easily find and compare in-network providers and facilities.

Get help finding in‑network care and benefits

If you don’t yet have a myWellmark account, you can find in-network providers and facilities on Wellmark.com.

Have questions about in-network benefits or finding in-network providers? Call Wellmark Customer Service at 800-524-9242 (TTY: 888-781-4262), Monday–Friday, 7:30 a.m.–5 p.m., Central Time, and be sure to have your member ID card on hand.