Health Insurance Basics: Understanding the Difference Between a Network and a Carrier

Navigating health insurance can feel like learning a new language. Among the many terms you’ll encounter are "network" and "carrier." Understanding the difference between these two important aspects of health insurance is essential for making informed decisions about your healthcare coverage. In this post, we’ll break down what networks and carriers are, how they work together, and use MultiPlan Network as an example to illustrate these concepts.

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What is a Health Insurance Carrier

A carrier is the health insurance company that provides your health coverage. They are responsible for underwriting your policy, determining your premiums, and paying for the claims based on your plan’s coverage. The carrier essentially manages your health insurance plan and ensures that you’re covered for the services included in your policy.
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Examples of Carriers:

• Blue Cross Blue Shield
• UnitedHealthcare
• Aetna
• Cigna
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These companies, known as carriers, design various health insurance plans with different levels of coverage, premiums, and out-of-pocket costs. When you purchase a health insurance plan, the carrier is the entity that provides the actual insurance and handles claims.

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What is a Health Insurance Network?
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A network is a group of doctors, hospitals, and other healthcare providers that have agreed to provide medical services to members of a particular health plan at discounted rates. Insurance carriers negotiate these rates with healthcare providers to create a network, which helps control costs for both the insurer and the patient.
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When you enroll in a health insurance plan, your carrier offers access to certain networks. Visiting healthcare providers who are "in-network" means you’ll pay lower out-of-pocket costs, as these providers have agreed to the carrier’s negotiated rates. On the other hand, going "out-of-network" often means higher costs, as these providers don’t have a contract with your insurance company.

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How Do Carriers and Networks Work Together?
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Think of it this way:
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• The carrier is the company that administers your health insurance plan and pays for covered services.
• The network is the collection of doctors, hospitals, and other providers that agree to treat you at lower, pre-negotiated rates.

Your health insurance carrier works with various healthcare networks to give you access to providers at discounted rates. When choosing a plan, it’s important to check which networks are available through that carrier to ensure your preferred doctors and hospitals are in-network.

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Example: MultiPlan Network
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To illustrate this, let’s use MultiPlan as an example. MultiPlan is not a carrier, but a network. It provides a large group of healthcare providers, hospitals, and specialists that have agreed to lower their rates for patients who are insured through a participating carrier.

Here’s how it works:

1. Carrier Example: Let’s say you have a health insurance plan from UnitedHealthcare.
2. MultiPlan Network: Your UnitedHealthcare plan might use the MultiPlan Network. This means that healthcare providers who are part of the MultiPlan Network have agreed to offer services to you at discounted rates. As long as you see a provider who is part of the MultiPlan Network, you will pay lower out-of-pocket costs.
3. In-Network Savings: Because MultiPlan has pre-negotiated rates with these providers, your visits to in-network doctors or hospitals will cost less compared to out-of-network providers, who have no agreement with your insurance company.
4. Out-of-Network Costs: If you decide to see a provider who is not part of the MultiPlan Network, you’ll likely pay more because those providers haven’t agreed to offer discounted services to patients with your plan.

Key Takeaway:

• UnitedHealthcare is your carrier—the company that administers your health insurance plan.
• MultiPlan is the network—the group of providers you can visit for discounted rates.

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Why It’s Important to Understand the Difference
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Understanding the difference between a network and a carrier helps you make better decisions when choosing and using your health insurance plan. It’s not enough to just select a good carrier; you need to make sure your healthcare providers are part of the network used by that carrier to keep your healthcare costs low.
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• Before Enrolling: Always check if your preferred doctors, hospitals, or specialists are part of the network included in the plan you are considering.
• While Using Your Plan: Make sure to stay within your network whenever possible to avoid unnecessary out-of-pocket expenses.

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Conclusion:
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When it comes to health insurance, your carrier is the company that provides your health coverage, while the network is the group of doctors, hospitals, and providers you can see at discounted rates. For example, if you’re enrolled in a UnitedHealthcare plan that uses the MultiPlan Network, you’ll benefit from lower costs when you visit providers within that network.
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By understanding how these two components work together, you can choose the right health insurance plan and manage your healthcare costs more effectively. If you have any questions about networks, carriers, or how to find the best plan for your needs, feel free to reach out to us at Better Health Consulting. We’re here to guide you through the process!