Know the Difference: In-Network vs. Out-of-Network Benefits

October 8, 2024

We’ve recently received several questions from NYCDCC members regarding the costs associated with visiting Out-of-Network providers. To help our members better understand their benefits and avoid paying high Out-of-Network rates, we’re providing this summary of both your In-Network and Out-of-Network benefits.

Out-of-Network Benefits:

Under the NYCDCC Welfare Fund, you have both In-Network and Out-of-Network benefits through Independence Administrators (“IA”). However, it is more costly to you when using Out-of-Network providers. Out-of-Network benefits have higher Annual Deductibles, Coinsurance, and Out-of-Pocket Maximums. In addition, you can also be balance-billed for any difference between the Out-of-Network rate and the billed amount.

For a detailed comparison of the In-Network vs. Out-of-Network cost sharing options, refer to the chart on the Out-of-Network Benefits flyer provided here.

How to Avoid Paying Out-of-Network Costs:

Whenever possible, you should ask if a provider is in IA’s network. It is not enough to ask if a provider merely “accepts” your insurance because they may be doing so at the Out-of-Network rate. It is up to you to make sure you use In-Network hospitals, facilities, and/or doctors so that you can save money. In fact, even if your In-Network primary physician refers you to another doctor and/or facility, you should make it a habit to ask if the suggested doctor and/or facility is in IA’s network.

Three Ways to Find In-Network Providers:

1. Log into your account at www.MyIBXTPAbenefits.com

2. When scheduling an appointment with a new provider, make sure to confirm they are in-network.

3. Call IA at (833) 242-3330 and ask them to check for you.