When you think of the word “network,” the first thing that pops into your head probably has something to do with your wireless carrier. For health insurance, finding the right doctor to accept your insurance is all about another type of network.
Health insurance policies change about as often politicians change their minds. What you have today can be gone as soon as tomorrow. Therefore, you should closely monitor the changes in your health insurance policy, especially when involves finding a doctor.
Benefits of Seeing an In-Network Doctor
Let’s say you have consulted with the same physician for more than 10 years. Suddenly, your employer decides to change health insurance carriers. The physician you have consulted with for the past 10 years is not listed as an accepted provider in your employer’s new network. Do you stick with your current physician or should you choose a doctor who is listed in your employer’s network?
Here are four reasons why staying in-network makes more sense:
Physicians in your network work out deals with your insurance company that can save you money on premiums. In-network coverage also can include lower deductibles and co-payments than the deductibles and co-payments charged by providers that operate outside the network.
You should benefit from a smoother paperwork processing system when you stay in-network for medical care. Your insurance company has established relationships with the same providers, which means a coordinated system for sharing information should be in place.
Higher Quality Care
Network providers must follow specific standards of quality that you might not receive if you go outside a health insurance network. From diagnostic tests to rehabilitation regimens, you should receive better health care inside a provider network.
Lack of Coverage
Many health insurance policies penalize policyholders that go outside the network in the form of higher monthly premiums, deductibles, and co-payments. However, some health insurance policies prohibit policyholders from seeking medical care outside the network.
Finding a Doctor Who Accepts Your Health Insurance
Now that you understand the benefits of staying in a health insurance network, let’s discover how you find a doctor that accepts your insurance.
Contact the Provider’s Office
Just because one physician at a medical practice is listed in your health insurance policy’s network does not mean other physicians list in the same network. Call the medical practice and ask about each physician that works at the practice. You can ask a question such as “Is Dr. John Smith a member of the network for Blue Shield Gold 80 PPO.” Make sure to tell each medical practice whether you have a government marketplace plan because some practices do not accept marketplace insurance policies.
Contact the Insurance Company
Contacting your insurance company should verify whether a healthcare provider is part of the company’s network. Your insurance carrier can check a healthcare provider’s tax identification number. You get a provider’s tax identification number by calling the practice where the provider works and asking for the number.
Many insurance companies offer a feature called “Find your doctor” on their websites. The “Find your doctor” feature lists which healthcare providers are part of specified health insurance policies. For example, if your health insurance carrier is Blue Shield, you can visit the company’s Find a Doctor web page to determine whether your physician is part of the Blue Shield network for your health insurance policy.
Other health insurance carriers offering a “Find a Doctor” feature that have a national presence include Aetna, Humana, and United HealthCare. You simply type in the name of the healthcare provider and hit the search tab. If you are searching for a new healthcare provider, then use the health insurance carrier’s online directory to search for an in-network healthcare provider who practices in your area.
Losing Your Employer’s Coverage
Can you continue to consult with the same doctor if you have lost the coverage provided by your employer? The answer is it depends. If you enroll in a new plan during the limited time Special Enrollment Period, then you should check with your doctor to determine whether the healthcare provider is part of your new network.
If you decide to see an out-of-network healthcare provider, you have to find out whether your health insurance carrier covers a portion of your medical expenses. PPOs and POSs typically cover a portion of the costs associated with a visit to your physician. However, HMOs and EPOs do not cover out-of-network healthcare costs.
Learn more in Furlough vs. Layoff: How Does Each Affect Your Health Insurance?
The Bottom Line
The many benefits of staying within a health insurance carrier’s network far outweigh the hassle of having to find a new doctor. If your health insurance coverage changes for any reason, finding doctors that accept your health insurance involves contacting the doctors and your insurance company, as well as using the “Find a Doctor” feature that is a part of many health insurance company websites.
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