Shopping for health insurance requires the consideration of several factors, including cost and the extent of coverage. One of the factors omitted by many consumers concerns the list of doctors that operate within a network established by an insurance company. In other words, one of the questions you should ask is “How do I know if my doctor is in-network?”
You have established a strong relationship with your physician. The last thing you want is to purchase a health insurance policy that does not allow you to see the doctor with whom you have developed a trusting professional relationship. Going to your preferred doctor who is listed in your health insurance provider’s network ensures you get the most out of your policy while at the same time minimizing healthcare costs.
Determining whether your doctor is part of your health insurance plan’s network is not always easy to do. Just because a healthcare provider accepts your insurance plan does not mean the healthcare provider is part of your network.
What Differentiates In-Network and Out-of-Network Health Insurance Coverage?
The goal of insurance companies is to recruit and retain the most affordable healthcare providers that offer the most extensive list of healthcare services. Most insurers take steps such as reviewing patient surveys and reviewing claims information to determine the best healthcare providers for their networks. Insurers negotiate the most favorable price arrangements with the healthcare providers that join their networks. This means when you schedule a visit with an in-network healthcare provider, you receive healthcare services at discounted prices.
In most cases, health insurance plans offer lower rates for copay, coinsurance, and deductibles. These costs provide you with additional savings in addition to the price that you pay for healthcare services. If you visit a doctor who is out of your health insurance plan’s network, you can expect to pay more for healthcare services, as well as pay more for copay, coinsurance, and the annual deductible.
How Do I Determine Whether My Preferred Physician is in My Health Insurance Plan’s Network?
Before you sign on the dotted line for a health insurance plan, you should first determine whether your preferred doctor is listed in your plan’s network of healthcare providers.
Start by Going Online
Most insurance companies that offer health insurance coverage have created a “Find Your Doctor” feature on their websites that lists which physicians are part of a healthcare provider network.
Here is a short list of some companies that have the “Find a Doctor” search feature on their website:
You should be able to search by name to determine whether your doctor is part of a health insurance plan’s provider network. However, the list of in-network physicians changes almost daily, which means the database that you access might not be accurate. Your physician’s website also might provide you with information concerning the health insurance plans honored, but once again, the list of plans might not be updated.
Since websites might not be updated with accurate information, you should approach your research with a confirm everything approach.
Call Your Doctor and Health Insurance Company
You have accessed the online tool provided by your insurance company and healthcare provider to determine whether your physician is in-network. Now, you should call both your doctor and health insurance company to confirm your doctor is part of the network of healthcare providers.
When you call your health insurance company, mention your physician’s tax identification number to speed up the discovery process. In addition, make sure to have your health insurance policy easily accessible to verify certain information such as the type of plan and the amount of costs like copay and coinsurance.
You should write down your insurance company customer representative’s name and ID number, as well as ask for verification of your in-network list of healthcare providers by having it sent to your home through snail mail.
How Do I Find a New Doctor?
If you decide to save money by visiting a different doctor who is in your health insurance plan’s network, ask your current physician for a recommendation. Your current doctor might know of a colleague who is in-network that takes a similar approach to providing healthcare services. Ask friends and family members for recommendations as well. Websites such as Healthgrades and Physician Compare also might help you find a new doctor who is listed in your health insurance plan’s network.
When the time comes to choose a new physician, follow the same steps that you followed to determine whether your current doctor is listed in your health insurance policy’s healthcare provider network. If you choose a new physician who is out-of-network, the choice can mean you get stuck with substantially higher medical bills.
The Bottom Line
If you need assistance navigating all of these options, Insurance Broker Hub can help. Our free service gives you access to an independent network of national brokers who have the experience and expertise to design a plan around your needs and budget. Ready to get started? Simply request a no obligation health insurance quote here.