What Does In-Network and Out-of-Network Really Mean?

Insurance is confusing

Understanding health insurance is not easy — even for physicians. For patients and families, it can feel even more overwhelming.

One common source of confusion is that being treated at an “in-network” hospital doesn’t always mean every doctor you see there is also in network. If a physician or specialist working in that hospital isn’t contracted with your insurance, you may still get billed at out-of-network rates. This is often how “surprise bills” happen.

Recent Insurance Network Changes

You may have heard that Johns Hopkins is now out of network with UnitedHealthcare (UHC). This means the hospital and the insurance company could not agree on contract terms for payment. Put simply, they were not able to reach a fee arrangement that both sides felt was fair.

What Does This Mean for Patients?

• If you have UHC insurance and receive care at Johns Hopkins, you are now considered out of network.

• This could mean higher out-of-pocket costs, depending on your plan’s out-of-network benefits.

• The hospital may or may not provide you with exact costs before your visit.

The No Surprises Act (a federal law) helps protect patients in some of these situations. For certain services, you must be given a Good Faith Estimate so you have an idea of what you may be charged. Still, costs can be unpredictable.

How Kidney MD is Different

At Kidney MD, we take pride in transparent pricing. Our fees are listed clearly on our website for anyone to see — no hidden charges, no unexpected bills. Whether you are using Medicare Part B, submitting a superbill to your insurance, or paying directly, you will always know what to expect before your visit.

“So I have to pay upfront — does that mean I can’t use my insurance to see you?”

Not at all. It simply means you pay for your visit at the time of service. After that, depending on your insurance benefits, you can submit the bill (called a superbill) to your insurance company. If your plan includes out-of-network coverage, they may reimburse you for part or all of the cost.

You can use this link to check whether you have out-of-network benefits and how much your insurance might reimburse.

Our goal is simple: focus on your health, not surprise bills.

Insurance vs. Direct Care: What’s the Difference?

Traditional Insurance Model	Direct Care Model
Insurance company decides how much time and what services are covered	You and your doctor decide what care you need, without restrictions
Bills can be unpredictable — copays, deductibles, and surprise charges	Pricing is transparent — all fees are listed upfront
Shorter visits due to insurance requirements	Longer visits focused on prevention, education, and your goals
More paperwork and approvals	Simple: pay directly, get a superbill to submit to insurance if eligible
Focus often on treating illness once it happens	Focus on prevention, root causes, and long-term health

Patient FAQs

👉 If I have Medicare Part B, does this change anything?

No — Kidney MD continues to accept traditional Medicare Part B without changes.

👉 If I have UnitedHealthcare, can I still be seen at Kidney MD?

Yes! You are always welcome. Your visits would be billed as out-of-network, which may mean paying at the time of service. We provide you with a superbill you can submit to your insurance for possible reimbursement.

👉 How can I avoid surprise bills?

At Kidney MD, we make it simple: all of our prices are listed clearly on our website, so you know what to expect before your visit.