What is the difference between In-Network and Out-of-Network claims? How do you determine the difference?

Providers and insurance companies determine their “network” status through a contractual agreement in order to determine how claims will pay. To ensure you are getting the best benefits per your plan, you will want to make sure your providers (the facility and the doctor/dentist/surgeon) is In Network PPO Participating with your plan. The best way to determine this is by asking the provider and the facility prior to your visit because they oversee their contracts and are the first to know if anything changes. While you will always want to do this prior to a visit, you can start searching for potential providers by using Highmark’s MyCare Navigator team.

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