What is the difference between in-network and out-of-network providers?

The difference between in-network and out-of-network providers is based on the agreement between Highmark Blue Cross Blue Shield and healthcare professionals. In-network providers have a contract with Highmark, offering negotiated rates and discounted services to members. Choosing an in-network provider typically results in lower out-of-pocket costs for the member. Out-of-network providers, on the other hand, do not have a contract with Highmark, so their rates are not discounted. Members may still receive coverage for out-of-network services, but it usually involves higher deductibles, copayments, or coinsurance, resulting in increased costs. Therefore, it is advisable to consult the provider directory or contact Highmark to determine if a specific provider is in-network and obtain the most cost-effective healthcare services.