In-Network Care

  • Provider networks and in-network care

    Health plans have a specific group of doctors, dentists, pharmacies, hospitals, and other healthcare providers you can use at a contracted, in-network price. This is known as your provider network, or your network.

    Since you pay for part of the costs of your medical care, it’s important to know that you will almost always pay less with an in-network provider compared to an out-of-network provider.

    Beware of balance billing!

    With out-of-network doctors or hospitals, you should be aware of balance billing. Balance billing happens when your doctor bills you for fees that you wouldn't have to pay for with an in-network provider.

    Example: To help control healthcare costs, health plans have set prices for procedures and services with in-network providers. These cost savings for you are called allowable amounts. If you get care from an out-of-network provider, the provider may bill more than that allowable amount. With out of network providers you are responsible for the difference between the providers billed amount and your health plans allowable amount.

    A real-life example: An out-of-network provider bills $200 for an office visit, but your allowed amount is $150. In this case, the provider may balance-bill you the $50 difference*

    An in-network provider bills $200 for an office visit, but your allowed amount is $150. In this case, the provider would write off the $50 difference, at no impact to you.

    Balance-billed amounts often do NOT apply to any out-of-pocket maximums. So it's definitely in your best interest to find an in-network provider.

    Finding in-network doctors and other healthcare services

    At Premera our networks offer thousands of providers who deliver high quality healthcare for lower costs. Our Find a Doctor tool lists all the healthcare providers who are in network for our health plans.

    Provider networks vary from plan to plan. It's very important to know the name of the provider network you're interested in before searching in the Find A Doctor tool.

    Be a savvy healthcare consumer—and save money when you get care. Use an in-network provider whenever possible—and ask your doctor about in-network options when you need laboratory work, or when you need to be referred to a specialist.

    Exclusive provider organization (EPO) plans

    Our EPO plans use the Heritage Signature network, which includes major Washington healthcare systems, such as Seattle Children’s Hospital, MultiCare Health System, and UW Medicine. Premera members have access to leading hospitals, including Virginia Mason Hospital & Medical Center, Overlake Hospital Medical Center, Northwest Hospital, Evergreen Health, and more.

    PersonalCare Plans

    Premera's PersonalCare Plans offer care from a designated partner system, including The Everett Clinic, EvergreenHealth Partners, MultiCare Connected Care, Northwest Physicians Network, UW Medicine Accountable Care Network, and Virginia Mason Medical Center. We will match you with a partner system and primary care physician after you enroll. You can change your partner system by calling us at 855-494-1319. You can change your primary care physician by logging in to your secure Premera account. 

    Referrals are required to receive specialty or other care outside of your partner system. All other care outside of your partner system is covered only for medical emergencies.

    Do you already have a doctor?

    When selecting a health plan, it’s important to consider whether its network includes healthcare providers who will meet your needs. If you already have a regular doctor, you might want to see if that doctor is in the network.

    With the Find a Doctor tool, you can search for doctors by location, specialty, gender, languages spoken, and more. 

    *Dollar amounts provided are for example only.*Dollar amounts provided are for example only.