Health Insurance Articles
How To Find Out What Providers Are In Your Health Insurance Network
2010-03-13
One of the key ways in which a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) keeps costs for its clients low is to arrange for a network of care. Under this network, certain primary care physicians, as well as specialist and consulting physicians, agree to offer discounted rates for members. Health insurance coverage such as this typically has a wide-range of professionals to choose from, many which are local to the client but often some that can be used if the customer is out of state. This health insurance network is an integral part of any HMO or PPO health insurance coverage.
For clients of these plans, it is important to know who you can go see, and when. When a plan is first joined, your health insurance provider should supply you with a list of physicians that are in your network. If your current primary care physician is not among them, you may need to change doctors in order to receive the benefits of your health care. Although you could continue to go to an out-of-network physician and they could refer you to providers within the network, the initial cost to you would be higher and your plan would likely cover little, if any, of the treatments prescribed by that physician.
Physicians agree to participate in health insurance networks because they are paid by the providers. For this reason, the list of providers in your network can change periodically, as doctors change networks or move out of state. It is in your best interest to make sure you have the most up-to-date and accurate list of network providers before going to see any doctor. A few questions at the front desk of a doctor's office should be enough to confirm their standing in the network, but that is often not on a patient's mind when they go to the doctor feeling ill. Sadly, they will often feel worse after receiving a large bill for going outside of their network area, sometimes without their knowledge.
Once you receive any PPO or HMO health insurance quote, call the company and ask about their providers. Ask where they are, how many they have, and what the options are for going out of network, as well as for referrals. Some plans will mandate that a primary physician must give a referral before a specialist can be seen, and some allow free access to them as long as they are within the network. Making sure that you know who your providers are and what it will cost to see them is essential. This means that you will be making the best use of your health insurance coverage without spending extra money.
