Understanding Health Insurance Networks

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Oct. 29, 2026

Are you planning to visit a new doctor? Before setting up an appointment, you should consider if the provider is in your health insurance network.

Understanding your health insurance network can help you make informed decisions about your care. This can help you avoid unexpected costs.

What is a health insurance network?

A health insurance network is a group of doctors, hospitals, pharmacies, and other healthcare providers that work with your health plan to provide care at negotiated rates. Think of a network like a preferred list of healthcare providers that have agreed to work with your health plan.

The health plan and participating providers agree to negotiated discounted rates for covered care and services. This helps you know what your care will cost.

The rates won’t change if the provider wants to charge more. You know you will have discounted costs when you use an in-network provider.

In-network care will count toward your annual deductible and out-of-pocket maximums. Your deductible is the amount you pay out of pocket before your health plan starts to pay some of the costs. The out-of-pocket maximum is the amount you’ll pay for covered, in-network services in a plan year.

You can save money by staying in network even if you haven’t met your deductible.

How networks benefit members

The important thing to know about networks is that, when you use an in-network provider, you will typically pay less. In-network care is less expensive than out-of-network care.

You also benefit from a simpler process. In-network providers will file claims for you so that you don’t have to.

We are always working to maintain broad provider networks so members can access the care they need across their communities.

BlueCross BlueShield of South Carolina has one of the largest networks in the state, giving you a wide choice of primary care doctors, specialists, hospitals, and urgent care centers.

Our networks balance access, quality, and affordability for our members. These partnerships help you have coordinated, high-quality care.

Understanding in-network vs. out-of-network

Before scheduling a visit, check whether your provider is in your plan’s network. You can do this through our member portal and mobile app, My Health Toolkit®.

Care from an in-network doctor will usually cost you less. You’ll also have easier claims processing, since we have an established relationship with the office.

If you get care from an out-of-network provider, costs become unpredictable. Doctors or hospitals that are out of network have not agreed to set rates for care. Your care may cost more, and you may not get the same quality of care. You may also have to pay upfront and submit a claim for reimbursement.

Out-of-network coverage depends on your plan. Your plan may cover a smaller share of the cost or none. You may have a higher deductible or coinsurance for out-of-network care.

A provider may charge the difference between its price and what your plan pays. This is called balance billing. Out-of-network providers can set the price they want, and you would have to pay the difference in cost.

You can check your out-of-network coverage in your plan details when you enroll or through My Health Toolkit.

The rules are different for emergency services. The federal government has separate rules for out-of-network emergency care. That’s to protect you from surprise bills. Using an in-network provider is best in all scenarios, if possible.

How does it work?

You can use our Find Care tools to search for a doctor or specialist that is in network. Your cost will depend on what type of plan you have.

Once you visit an in-network doctor, he or she will submit the claim for your care on your behalf.

You can review your claims information on your Explanation of Benefits (EOB). This is a recap of the conversation about your care between your doctor and your health plan.

Why do networks change?

There are several situations that can cause your preferred doctor or hospital to leave your insurance network. Networks evolve over time. We add new providers. Some providers may leave.

We regularly negotiate contracts with these offices to ensure our members are getting quality care for reasonable rates.

Most network negotiations are completed successfully and allow our members to continue accessing care as usual.

When negotiations occur, health plans work to reach agreements that support both affordable coverage and continued access to quality care.

If your doctor or hospital is no longer in your plan’s network, you may wonder what this means for your care and costs. You may still be able to get care from your current doctor, but it could cost more. When this happens, you still have options. You can call the number on the back of your membership card for more information.

Our provider networks are large and always evolving. Our plans give members access to thousands of doctors and hospitals across the state. Our goal is to help you access high-quality care while keeping healthcare costs as affordable as possible.