Choosing Network Doctors

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Choosing Network Doctors

Meet Sophie. She’s been going to the Dr. Collins for years and trusts her completely. But now Sophie’s looking for a new health insurance plan. Naturally, the first thing she wants to know is how much it will cost. The second thing is if she can continue to see Dr. Collins. Makes sense. Sophie’s looking for a new health insurer, not a necessarily new doctor!

Chances are, Sophie can stay with the doctor she has. She just needs to find out if she participates in the new insurer’s network. Here’s how it works: Insurance companies pre-negotiate rates with doctors, hospitals, pharmacies and other medical facilities to provide services to its members at lower costs. Say Sophie needs to see an allergist during sneezing season. When she goes to an in-network doctor, she’ll pay less for the visit than when she sees a doctor outside the network. Pretty simple, right?

So how does Sophie find out if Dr. Collins is part of the insurer’s network before she signs on the dotted line? Most health insurance companies like Humana have a Provider Finder tool on their websites. It lets you search for all kinds of medical professionals in your area. If you want to see if your doctor participates, just plug in his or her name. If it pops up, they’re in! If you’re curious about other doctors in your area, you can search by zip code or specialty. You’ll get a whole list of results. You can find out which pharmacies, labs and hospitals are in the plan, too.

Another good reason to stay in-network? The insurance company checks the records of healthcare providers before signing them on. That way you can feel confident that you’re getting quality care. And they’ll take care of filing the claims for you. That’s one less headache to worry about!

Suppose you want to use doctors outside an insurer’s network? A couple of things to know. Some plans, like HMOs, don’t give you this option. You have to see doctors in their network. But this is no problem. HMOs have doctors in all sorts of specialties, from pediatricians to cardiologists.
Other plans let you go to out-of-network doctors, but you may not get as much coverage. There might even be an additional deductible. And you’ll be charged higher fees for services because they haven’t been negotiated in advance by your insurance company. You’ll be responsible for a larger portion of the bill.
Now that Sophie’s married and expecting, she made sure the hospital where she’ll deliver her baby is in-network. That leaves more money for diapers, rattles, and cute baby clothes.
Once you pick your insurer, be smart like Sophie. Stay with in-network providers. You’ll get the best care for less! It’s that simple.


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