Understanding Networks and Plans
Understanding how your plan works can help you avoid unexpected medical bills. Knowing the difference between in-network and out-of-network care can help you save on health care expenses.
What’s the difference between in-network and out-of-network?
In-Network: When you see a doctor, hospital or other provider who contracts with True Health New Mexico health insurance we say they’re in-network. We also call them participating providers. These participating providers must meet certain credentialing requirements to contract with us and have agreed to accept a discounted rate for covered services in order to be part of the True Health New Mexico Provider Network.
Out-of-Network: When you choose to see a doctor, hospital, or other provider who has not contracted with True Health New Mexico, they’re considered out-of-network and can charge you full price. The full price amount charged is usually much higher than the in-network discounted rate.
How to find in-network providers
- When you search for a provider on our website or mobile app, we only show you in-network providers. See the Find a Doctor link above.
- Remember, it’s always a good idea to call and ask before you go to a doctor or hospital if they are in your plan’s network.
What’s the difference between a PPO plan and an HMO plan when looking at the network?
First, it’s important to know if you have a medical emergency, go to the nearest hospital or urgent care.
However, when it’s not an emergency, PPO and HMO plans work differently. Understanding how in-network and out-of-network providers are covered between these two different types of plans can help you avoid unexpected medical bills.
HMO plans, or health maintenance organization plans do not include out-of-network benefits. That means if you go to a provider for non-emergency care who doesn’t take your plan, you pay all costs.
PPO plans, or preferred provider organization plans do include out-of-network benefits. This means your insurance plan will help pay for the care you receive from providers who are not part of the True Health New Mexico provider network. When choosing to receive care from an out-of-network provider, you will usually pay more than if you choose to see an in-network provider. Important: out-of-network providers have not contracted with True Health New Mexico and may charge more for services than is covered by the plan. This is often referred to as balance-billing.