When your insurance plan changes, one of the first questions you should ask is whether your regular doctor — or your team of doctors — is still in your network. Knowing who is part of your plan and who’s not can save you serious money.
Why Your Network Matters
Not all doctors work with every insurance plan. Doctors in your network charge lower rates than doctors outside your plan’s coverage. The type of plan you have also determines how much of your care, if any, your plan will cover if you go outside your network.
An exclusive provider network (EPO) or health maintenance organization (HMO) will have more restricted networks and less generous coverage for out-of-network care. Meanwhile, a point of service (POS) or preferred provider organization (PPO) policy will likely have a larger network and offer some reduced coverage if you go outside the network. Understanding how your plan works gives you more information about your full range of options.
3 Ways to Know If Your Doctor Is in Your New Network
Here are three simple ways to verify the doctors in your network and prepare for any changes.
1. Use Your Plan’s Website
The first and easiest way to check your network is to log in to your new plan’s website and search for in-network providers. You should be able to enter your doctor’s name and find out if they participate in your plan.
2. Contact Human Resources
You may have to sit through a waiting period before your plan starts. Even if you’ve gone through open enrollment, you may not immediately get a login. In that case, contact your human resources representative, if you have one, about your plan. They may be able to give you phone number you can call to talk to your insurance company directly about specific providers.
3. Call Your Doctor’s Office
A third way is to ask your doctor directly. Look through any plan information you have for accurate details on the name of the insurance company and the plan type. Then call your preferred providers to ask whether they accept that type of insurance.
What If You Have to Wait and See?
Sometimes you may not know much about your network until the plan begins. Stay prepared with a list of the types of doctors or specialists you regularly see. Look up reviews online, and make a list of your top two or three choices in case you need to change doctors to stay in network. Once you know your network, you’ll be prepared to make calls and interview new doctors.
If you have the option of investing in a health savings account (HSA) or flexible spending account (FSA), use it to set aside money every month. If your current doctor isn’t in your network, the savings from an HSA or FSA will help offset any additional costs of seeing an out-of-network doctor. You’ll also have a little more time to look for a new doctor without missing important appointments. Finally, see if you can make an appointment for a check-up or follow-up visit with your current doctor before the end of your plan. That will give you more time to consider your options once you’ve learned what they are.
But what if your favorite doctor isn’t in your new network, and you can’t stand the thought of changing? One option is to call your preferred doctor’s office and ask about self-pay rates. By choosing self-pay, you pay the doctor directly, bypassing insurance. These rates are often much lower than what’s charged to the insurance company. You can use HSA or FSA funds to pay for these visits — but keep mind that any self-pay amount you pay won’t count toward your plan’s deductible.
Health plan networks don’t need to be a mystery. As soon as you have access to the details of your policy and are eligible for coverage, log in to your plan’s website and begin your research. Sure, you’ll lose part of an afternoon, but knowing the doctors in your network will help you stay on top of your health and save money throughout the year.