What is the difference between in-network and out-of-network providers?
An in-network provider is one that is contracted with Magellan to provide services to plan members for specific pre-negotiated rates. An out-of-network provider is one not contracted with Magellan.
Typically, if you visit a physician or other provider within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network provider. Though there are some exceptions, in many cases, Magellan will either pay less or not pay anything for services you receive from out-of-network providers.
An additional benefit of in-network providers is that they will file claims on your behalf. If you choose to use an out-of-network provider, your out-of-pocket costs will typically be much higher, and you may have to pay up front for services and file claims with Magellan for reimbursement.