As with all things in health insurance and other types of insurance, it depends on the company and the policy that you have with the procedure for getting your health insurance company to add a Doctor into their network. This is not an easy process and, in some systems, this is not even possible. To get instant online insurance rates enter your zip code into the tool now.
However, let’s start from the beginning by discussing the types of health insurance plans available, definition of networks, why they came to be, and finish up with some tips for getting Doctors added to your preferred network.
What types of health insurance plans are there?
There are two main types of health insurance plans available. The first to be utilized was the traditional coverage, followed shortly by the more prevalent managed care plan. Of the traditional plans, there are two categories to choose from. Basic medical insurance will cover hospital, medical or surgery benefits only if necessary. Preventative care is not utilized and this will revolve around what the average costs are for the medical care.
The next type is major medical insurance. This takes the insurance plan to the next level by covering additional procedures and even certain continuing illnesses. Although it is important to know and understand the traditional plans, these policies typically won’t contain networks like the managed care policies do.
The next type of coverage is of course managed care and is the type that the majority of us are familiar with. Let’s explore the different types of managed care and the networks they contain. The first type is called a Preferred Provider Organization (PPO). In this type of managed care, insurers contract with specific providers to cut down on costs for the insured and speed up payments to the providers. This is where the terms “in-network” and “out-of-network” were born. In-network providers mean that the providers are contracted with your insurance company and thus will have lower copayments or other costs associated, depending on your chosen plan.
The next type is called a Health Maintenance Organization (HMO). In this type of managed care, the insured simply pay a monthly fee but have less flexibility regarding which doctors they can see when compared to a PPO. They will be assigned a PCP, or primary care physician, and they will need to obtain a referral from this doctor in order to see any specialist.
Another type of managed care plan is called Point of Service Plans. This managed care is a combination of the preferred provider organizations (PPO) and health maintenance organizations (HMO). At the “point of service”, you hold the option to pick whether you want to choose from a network of providers, inside and outside the network. Obviously the downside is depending on the choice, you can end up paying higher coinsurance.
Finally, there is a plan called Exclusive Provider Organizations (EPO).While similar to a PPO, you may only choose the offered contracted providers set out by your insurance company. Out-of-network does not exist, and thus would not be covered.
What is the purpose of provider networks?
So now that you understand what types of policies may contain “networks”, why do they exist? Ideally, they exist for the insurance companies to cut down on costs, and for the providers to get faster payments through the insurance companies. It actually helps to lower your insurance rates. It is a mutually beneficial relationship for the insurance companies and for the providers. And as mentioned before, it cuts down on costs for you as the consumer of this product.
So how do I get a Doctor added to a network?
Some companies provide request or suggestion forms, but more often than not, it happens as a result of the physician’s request to become part of the network. If you truly want your Doctor to be considered in-network for your health insurance company, your best bet is to talk to your Doctor to see if they are interested.
Depending upon the health insurance company that you have, the paperwork to do so could range from 2 pages up to 100 pages. They, or someone from their practice, will need to fill this out to become accepted as an in-network physician. However, another selling point you can use with your Doctor is that they would not only gain you as a patient, but many others within your health insurance company. Further, most health insurance companies don’t charge to be within their networks.
If you truly wish for your Doctor to become a part of your network with your health insurance company, start by asking your health insurance provider what the process is like. Once you understand what paperwork is necessary and how long the timeframe is, you can approach your Doctor or someone in his/her practice about joining your health insurance.
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