Why in-network providers matter

In-network vs. Out-of-network

When you see in-network providers, you’re getting the best benefit through your plan. That means the lowest co-pay, deductibles, and out-of-pocket cost. Provider networks are developed with members like you in mind. We contract with hospitals, doctors, and other providers who agree to give you the best possible, coordinated care for the best value.

”Out-of-network means a provider isn’t part of the Moda Health network. Some plans offer limited coverage for out-of-network care, while others may not cover it at all. When you see in-network providers, you can be confident you’ll get high-quality care at an agreed-upon rate, with fewer surprises on your bill.

Follow these 5 tips to get the most out of your benefits

1. Choose a primary care group today, even if you don’t currently need care. Having a designated primary care team can make it easier to schedule your appointments when it’s time to see your provider. We’ve made it easy. Just sign in to your Member Dashboard and select “Primary Care” from the “Find Care” dropdown menu.
2. Having surgery? Make sure your entire care team is in-network. It’s not unusual for a hospital to be in your network, but the anesthesiologist caring for you is out-of-network. Reach out to the Moda Health Customer Service team before you have surgery or a procedure. We can help make sure your entire care team is part of the Moda Health network.
3. Referrals might be out of network. Remind your primary care team that you want to see in-network providers when they refer you to a specialist or physical therapist. They can call us to make sure the provider they’re referring you to is in your network. If you already have a referral, contact the Moda Health Customer Service team so we can confirm for you before you go.
4. You have a say in where your lab work is sent. Something that many people don’t know is that your primary care team has many labs to choose from. And some of those labs may be out of your network. When you get bloodwork, or scans or images that need to be reviewed by a specialist, ask your provider to choose a lab or specialist that’s in your network.
5. Let us help you find care when you’re traveling. If you’re away from home and need care, you have options. Use your Member Dashboard or reach out to the Moda Health Customer Service team for help understanding your benefits and choosing a provider. We’ll help you get the best value and quality care, wherever you are.

Choosing your in-network provider

We’ve made it easy for you to select your in-network care team, either online or via our customer service team. All you need is your ID number, which you can find on your member ID card.

Online: Log in to your Member Dashboard at www.modahealth.com/dashboard and choose “Find care”

What happens if you go out of network

Depending on your plan, you may not have any benefits to cover the cost of out-of-network care. If your plan does cover some of it, your deductible and out-of-pocket cost will probably be higher. That’s because out-of-network providers don’t have a contract with us and can charge you more for care.

When you see in-network providers, you’ll get quality care for the lowest possible costs through your plan.

We build provider networks so that you get the quality care you deserve. If there is a provider you’d like added to the Moda Health network, you can nominate them! Just fill out the nomination form and we’ll reach out and invite them to contract with us.