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Choosing a Health Care Network

Choosing a Health Care Network

 

                When we think of networks, we may consider networks of friends, of co-workers or in tele-communications – a group of television or radio stations. When it comes to selecting a health insurance plan, a health network is one of the most important features to consider          .

                A health network is made up of the different health-care providers with whom an insurance company has contracts to deliver health-care services at negotiated fees. Most insurers contract with all types of providers: physicians, surgeons, therapists, hospitals, pharmacies and labs.

                Your insurance company will provide you with a list of all of the current providers in its network. Reviewing the list of network providers is important to see if the doctors, hospitals and other health-care providers you already see for health care, or would like to see for health care, are on that list.

                Your health plan also may have a preferred network and a non-preferred network of providers. The plan may provide more cost assistance with the preferred network, although you still can choose a non-preferred provider and pay a higher portion of the cost. If a provider is under contract, that provider is considered “in-network.” If the provider is not under contract, that provider is considered “out-of-network.”

                The most important difference between using an in-network provider and an out-of-network provider is cost. Many insurance plans encourage you to use in-network providers by offering lower deductible, coinsurance and copay amounts when you use network providers. That does not mean that you cannot use other providers. But if you do choose to use an out-of-network provider, the insurance plan’s share of the costs will be less than if you used an in-network provider. You will pay more for services. Some health plans may not cover any of the costs when you see an out-of-network provider.       

                Some plans instruct you to visit a primary-care provider (usually an internist or a family doctor) before seeking a consultation from a specialist. In those plans, the primary care provider is the one who gives you a formal referral to a specialist if you need specialty care. A visit to a specialist may have a higher copay or coinsurance. Also determine if the specialist is in-network or out-of-network.

                Because most networks feature local health-care providers, you will be faced with an added out-of-network expense if you need medical care while you travel. Some plans allow you to use out-of- network providers in a medical emergency. Ask your insurance provider how it handles medical expenses incurred when you travel away from home.

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