Your coinsurance, deductible and out-of-pocket maximum are less when using in-network providers. Plus, in-network providers agree to accept our payment for covered services and cannot balance bill you for the difference between their charge and the CoOportunity Health allowed amount.
In-Network versus Out-of-Network. What’s the Difference?
The first step to getting care is to find the appropriate healthcare professional or facility for the services you need. To get started, you need to understand how the provider network works, what it means to be “in-network” and “out-of-network,” and how selecting a particular provider affects how much you pay for care.
In-Network Providers
In-Network providersare the groups (network) of healthcare professionals and healthcare facilities participating with CoOportunity Health. These individuals and places work directly with us to accept your insurance coverage. Using an in-network provider is very important to all CoOportunity Health plans—when you have Premier, Choice or Preferred plan coverage. Here are some advantages
-
Lower out-of-pocket costs: Your coinsurance, deductible and out-of-pocket maximum are less
-
Less paperwork: In-network providers file claims and handle notifications for you so you don’t have to worry about them
-
Savings: In-network providers agree to accept our payment for covered services and cannot balance bill you for the difference between the allowed amount and their charge
Out-of-Network Providers
Out-of-network providers are healthcare professionals and facilities that CoOportunity Health does not work with directly. You may or may not still have insurance coverage when you use them, depending on your plan. If you do have coverage, the amount (how much your insurance plan pays) may be significantly less. This means you pay more of the costs for care. CoOportunity Premier and CoOportunity Choice plans provide out-of-network coverage, but you will have significantly higher copayments and/or coinsurance amounts, and, many plan designs have separate deductibles and out-of-pocket maximums for out-of-network services.
Matching Networks to Health Plan Offerings
CoOportunity Premier Plans
CoOportunity Premier is a PPO plan that features broad provider choice. You will save when you receive services from an in-network provider. Out-of-network coverage is available from providers that do not participate with CoOportunity Health, but your member responsibility for cost sharing will be higher.
If you are enrolled in this plan (any metal level or group plan design), your provider network is called Midlands Choice Premier. This network includes providers in Iowa and Nebraska as well as bordering states, giving you a broad choice of in-network providers:
-
20,000 physicians and other healthcare professionals
-
320 hospitals
-
1,500 other healthcare facilities
-
100 percent of the hospitals and 97 percent of the clinicians in Nebraska and Iowa
Find a CoOportunity Premier/Midlands Choice Premier in-network doctor, clinic or hospital using the provider search tool.
CoOportunity Choice UIHA Plans
CoOportunity Choice UI Health Alliance is an open access tiered benefit plan. You can manage your out-of-pocket costs based on three categories (or tiers) of providers.
Tier 1 in-network providers feature the member organizations of UI Health Alliance, plus additional facilities and clinicians in select Iowa counties.
-
Your out-of-pocket costs are lowest with Tier 1 providers
-
Four premier Iowa healthcare entities that are member organizations of UI Health Alliance are included: Genesis Health System, Mercy-Cedar Rapids, Mercy Health Network, and University of Iowa Health Care
-
Additional facilities, clinics and practitioners in select Iowa counties
-
All of these providers are a sub-set of Midlands Choice Premier network
-
Overall, the network includes 60 hospitals and more than 11,500 primary care clinicians, specialist and other practitioners
Tier 2 in-network providers include additional providers that participate in the Midlands Choice Premier network.
-
Your out-of-pocket costs are higher with Tier 2 providers
-
Tier 2 providers broad provider choice. See Midlands Choice Premier description above
Find a CoOportunity Choice UIHA in-network doctor, clinic or hospital using the provider search tool
CoOportunity Preferred UIHA Plans
CoOportunity Preferred UI Health Alliance is an Exclusive Provider Organization (EPO) plan which means that you have health insurance benefits only when you receive care from in-network, participating providers. There are no out-of-network benefits available.
CoOportunity Preferred UIHA in-network providers feature the member organizations of UI Health Alliance, plus additional facilities and clinicians in select Iowa counties.
-
You must obtain care from an in-network provider; no out-of-network benefits
-
Four premier Iowa healthcare entities that are member organizations of UI Health Alliance are included: Genesis Health System, Mercy-Cedar Rapids, Mercy Health Network, and University of Iowa Health Care
-
Additional facilities, clinics and practitioners in select Iowa counties
-
All of these providers are a sub-set of Midlands Choice Premier network
-
Overall, the network includes 60 hospitals and more than 11,500 primary care clinicians, specialist and other practitioners
Find a CoOportunity Preferred UIHA in-network doctor, clinic or hospital using the provider search tool