Health insurance agent, Michelle Bungo, explains doctor networks and finding the right care.
A doctor network, or provider network, is a catalog of hospitals, doctors, and other healthcare professionals that are covered with your health insurance. Each office has a contract with health insurance companies to offer care at a discounted rate. Michelle Bungo explains that the providers on the list are considered to be “in-network” and are your best chance at landing affordable care. If you choose to go “out-of-network,” your bill may be partially covered or not covered at all.
When choosing your health insurance plan, consider the four types of networks available:
HMOs only cover healthcare costs from in-network providers and require referrals for seeing specialists.
If you are looking for something with more flexibility, consider choosing a PPO. The PPO plans typically have higher monthly premiums, but pay for partial coverage if you want a doctor outside of your network. Additionally, PPO accounts allow you to see a specialist on your account.
EPO plans are a mix of the two mentioned above. People with EPO plans will only receive coverage from in-network providers, but they can go to specialists without a referral.
Finally, POS plans offer partial out-of-network coverage but require referrals for specialists. POS plans are also considered to be a hybrid of HMO and PPO.
Although this seems pretty straightforward, Michelle Bungo notes that it can be quite challenging to find an in-network doctor. When you start looking, make sure you have our insurance card in hand. It will tell you the plan name, tier, and network type.
- Call the Office
Always contact the potential provider’s office to make sure they take your insurance plan. Michelle Bungo notes that not all doctors at the same medical practice even take the same insurance plans. When you make the call, have your health insurance card in front of you so that you can quickly answer their questions. Make sure you are as specific as possible to avoid any mix-ups! Sometimes, doctors practice at multiple locations. Not all locations are equally covered, so make sure you choose the right one.
- Contact Your Insurance Provider
If you are having trouble reaching busy doctors’ offices, this option may be the most helpful to you. Michelle Bungo recommends this step because insurance carriers can use tax ID numbers to check for in-network providers for you. Make sure you know the potential healthcare providers’ tax ID number and your specific plan for a smooth process.
- Search Online
Finally, you can check to see if your health insurance provider offers a “find your doctor” search on their website. This is a relatively new feature that shows which doctors in your area are covered under all their plans. If you have an idea of which office you’d like to visit, Michelle Bungo recommends searching by the doctor’s name. If you are looking for a new doctor, the online directory can help you start in the right direction.
If you still need help, consider contacting your health insurance agent so they can go over your plan and its options.