Your Health Plan’s Provider Network

One of the biggest challenges in our medical system is the rising cost of care. Every health care expert and economist points to a different culprit for this. But no matter who’s to blame, there’s no escaping the fact that medical care is always getting more and more expensive.

To lower the cost of health care, health insurance companies have created managed care plans. These are the most commonly available plans, and include HMOs, PPOs, and POS plans. The defining feature of a managed care plan is the health care provider network.


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It works like this: insurance companies create a network of doctors, hospitals, clinics, medical specialists, and pharmacies.

The insurance companies negotiate with the care providers of that network to get discounts on medical services. These discounts mean that the insurance companies’ costs are lower, which means lower rates and out-of-pocket expenses for health plan members.

In return for the discounts, the health care providers benefit from the extra business they get by joining the network.

Enrolling in a managed care health insurance plan has its downside, though. Managed care plans give you less flexibility when it comes to making decisions about your care. And if you aren’t careful about the health care providers you choose, you could end up paying a lot more out of your own pocket than you anticipate.

That’s why it’s important to understand your health plan’s provider network.

Understanding Your Network

Managed care plans divide health care providers into two categories: in-network and out-of-network. In-network providers are members of the plan. Out-of-network providers aren’t.

If you have a managed care plan, you’re almost always better off choosing an in-network health care provider. Your plan will give you more coverage with in-network providers than with out-of-network providers. Some plans — most notably HMOs — won’t give you any coverage if you receive care from outside the network.

How do you determine who is and who isn’t in your plan’s network? Fortunately, the insurance companies make it easy. When you enroll in a plan, they’ll give you a list of providers to choose from. Many of the larger companies have online tools that let you search for in-network providers located near you.

What if you already have a doctor — and your doctor isn’t in the network? Consider joining one of the more flexible plans, such as a PPO. You’ll still get some coverage for the care you receive from this doctor, and you can use in-network providers when you need more expensive care from hospitals or specialists.

So which kind of health insurance plan is right for you? Start comparing rates and benefits. Get an instant online quote to see how different plans from leading companies stack up with each other. Or get competitive quotes from local agents for expert advice.