A provider who has a contract with your health insurer or plan to provide services to you at a discount.
The term is often associated with another term, participating providers.
♦ Participating providers also contract with your insurance company, but your plan may consider some to be preferred.
To explain this another way, there is a network of providers and within this network of providers are some that your insurance company considers preferred.
♦ The preferred providers are usually the ones that have negotiated the lowest costs with the insurance company. Most of the time the member will experience a lower cost by used the preferred provider.
♦ BlueCross BlueShield has taken this approach with some of their plans.
They have pharmacies that are participating pharmacies. Pharmacies that are in their network.
And then within this list of participating pharmacies are some that are referred to as preferred.
• Prescriptions will be covered at all participating pharmacies but the copay will be less if the member uses the preferred pharmacy.
• Why you should use in-network ?
• Why you might use out-of-network ?