Our physicians are our partners in health and healing. They assist us through challenging illnesses and joyful occasions, like the birth of a child. They know our private concerns and the most personal details of our lives.
It’s only natural that the relationships we build with our health care providers are some of the more intimate, emotional bonds we forge in life. That kind of trust takes time to build. So, it makes sense that, for many of us, one of the key factors in choosing a health plan is whether or not we’ll be able to keep our current doctors.
The answer to this question—as in so many things in life—is “maybe.” To understand what this means for you, you’ll first need to understand the term “network.”
Usually, your health insurer’s network contains physicians who practice in relatively close proximity to you. More specifically, your insurer’s network consists of health care providers who have agreed to accept the plan’s proposed amount for the services they provide.
Let’s say a doctor in your town charges $190 for a routine office visit. If your provider’s approved amount is $100, the doctor will agree to accept this reduced rate in exchange for the increased volume that comes with being part of the network.
Your health insurer’s network may or may not include your family or personal doctor. What does that mean for you?
If your preferred provider is outside of your insurer’s network, no agreements exist between two entities. In other words, an out-of-network provider is under no obligation to deliver services at your health plan’s approved rate. So, if you choose a provider who is out-of-network and he or she charges a higher amount for services than your insurer’s approved amount, you will, more than likely, need to pay the difference between those two amounts.
None of this means that you absolutely have to give up your doctor if he or she is out of your plan’s network, but it probably means you’ll have to pay more out-of-pocket for the services they provide, which defeats the purpose of paying your insurance premiums each month.
How do you know if your preferred provider is in-network or out-of-network?
The best way to be sure is to closely read your policy. And make sure to reach out to your health insurance provider if you still don’t understand. You can also call ahead to the provider or the hospital to inquire about whether or not they’ll accept your health care coverage.
A little knowledge and preparation can go a long way toward ensuring a health issue doesn’t cause a catastrophic financial event for you.