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Health Insurance Explained

Updated: Oct 12, 2021

The purpose of Health Insurance is to decrease the cost of medical services. A medical facility will bill your insurance company to receive reimbursement for services they provide, which decreases the cost you have to pay. They do this by submitting a claim to your insurance company using your plan number or ID .

There are two categories of insurances:

In-Network (IN) and Out-of-Network (OON).

IN means there is a pre-arranged term of reimbursement and contracted rate for medical services prior to visitation. The benefit of this category is it tends to provide cheaper medical services. However, facilities have to abide by insurance company policies, which sometimes is not what the patient needs, potentially limiting crucial medical services.

OON services allow a provider to bill the insurance company but are not contracted to be part of the network. The benefit of this category allows a facility to provide greater medical services in less crowded facilities. Individuals who choose OON services are free to select their medical provider with no constraints from the insurance company.

In Network:

  • Your providers are chosen for you from the insurance network

  • May not provide the medical services you need

  • Overcrowded facilities

  • Beholden to insurance companies

  • Tends to be cheaper

Out of Network:

  • Get to choose your provider

  • Select the medical services you want

  • One on one care

  • Tends to be more expensive

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