Each insurance company “contracts” with hospitals, doctors, nurses and other medical providers who agree to charge a discounted price for their services. This group of providers is called a “network.” Most plans only cover you if you get services from a medical provider in your network, although there are some exceptions which is an out of network provider.

What kinds of networks are there?

• HMOs only cover you if you stay in-network and often require referrals to see specialists.
• PPOs often have more expensive premiums (monthly payments), but offer partial coverage if you go out-of-network and don’t require referrals to see specialist.
• EPOs also only cover you if you stay in network, but you can see specialists without referrals. Think of them as in-between an HMO and a PPO.

How do I know if a doctor I’m seeing is in my network?

Unfortunately, doctor networks aren’t always as straightforward as they should be (welcome to the world of health insurance!). If it gives you a headache, you’re not alone. That’s why we’ve put together some tips to make the process easier:

Trek Tip 1: Know your plan. Get familiar with your plan’s name, metal tier, and network type. This should all be available on your insurance card.

Trek Tip 2: Ask your doctor. Call the doctor you plan on visiting and ask if he/she is “contracted” by your plan. Make sure to give them those specific plan details so they can get you accurate information.

Trek Tip 2a: Doctors often practice at different facilities and all locations won’t be covered by your plan, so make sure your visit is at the right office. If you’re misbilled for an out-of-network visit, double check…there’s a chance your doctor just put the wrong location on the paperwork. Good times, right?

Trek Tip 3: Do online research. Many health insurance companies have a “find your doctor” feature that lists which doctors are covered by which plans. Sometimes insurance companies will refer to their doctors as “providers.”

Trek Tip 4: Google your hospital or doctor’s office. Can’t get info from anyone else? Explore the actual health care facility’s website. They often have lists of the health insurance companies and plans they accept.

Note: double-checking with your doctor via phone is always your safest bet. Health insurance companies tend to be slow at updating their websites. Gotta love it! 

Trek Tip 5: If you end up being charged for an out-of-network visit, you may be able to appeal…especially if you can prove the visit was medically necessary and you couldn’t get the care you needed in-network.

Trek Tip 6: If your doctor leaves your network, he/she should notify you and you may be required to find a new one. However, some companies like Blue Cross Blue Shield will let you continue to see the doctor in special circumstances (you’re in the 2nd or 3rd trimester of a pregnancy, you’re being treated for a terminal illness, etc.).

Still feel helpless? Don’t sweat it. Contact us Info@TrekInsuranceGroup.com