In network doctorsThe health insurance industry has been one of constant change in the past few years. 2017 brought numerous changes for many policy holders and those looking to purchase insurance. With many insurance carriers looking to lower cost for consumers, they made the decision to change their networks. Many companies shrunk their networks where others completely terminated networks and implemented new ones.

Regardless of the type of change, one fact remains critical for policyholders. Make sure you are using an in network doctor or facility.

What are In Network Doctors?

An in network doctor is one that a plan has contracted with to provide medical care to its members. Depending on the type of plan you have, visiting in network doctors will either provide you with the greatest coverage or be your only way to receive covered services.

A PPO In Network provider is a physician, other professional provider, contracting hospital or contracting other facility provider that is included in a limited panel of providers as designated by your insurance company and for which the greatest benefit will be payable when one of these providers is used.

A HMO Network provider is a provider that is included in a limited panel of providers as designated by your insurance company as a health insuring corporation. Providers in this HMO Network have an agreement with your insurance company about payment for covered services.

The Difference Between a PPO and HMO Health Plan.

Very simply, if you have a PPO Plan, you can chose if you use a provider in the network or one not in the network. You will receive better benefits at a lower cost if you use in network doctors and facilities. However, if you go to an out of network doctor there are still some benefits under your health plan. (Usually a higher deductible, co-insurance and he provider can balance bill you for the amount not paid by your insurance carrier).

If you chose a HMO Plan, you will only have insurance coverage if you visit in network doctors and facilities. If you go to a doctor that is not in the network, you will not have any insurance coverage. Therefor, that means you will be responsible for the full cost of the visit.

How Do I Find Out Who Is In My Network?

There are several ways to find In Network doctors.

  • Call the customer service phone number on the back of your ID Card.
  • Visit your insurance companies website. When you visit the website, make sure you choose the correct network name. It’s not uncommon for insurance companies to have 10+ different networks. it is VERY IMPORTANT you select the correct one. Helpful tip – if you create a login with that company it will generate a list based off your specific network.
  • Call your insurance agent or broker.

Networks change often so it is important to re-check before every appointment. Just because your doctor was in the network in January, does not mean they are still part of it in August.

Individual insurance policies (policies your purchase on your own, not through an employer) have been hardest hit by these network changes. Anthem BC&BS networks have shrunk by almost half and Medical Mutual of Ohio went from a PPO network to a HMO network in 2017. With the new president, there is a good chance insurance plans, networks and prices will continue to change.

Click here to learn more about Individual Health Insurance

Click here to learn more about Group Health Insurance

It can be a full time job keeping up with all the changes. That’s why were here to help. If you need help looking for a plan or understanding your current plan, give us a call today.