How To Find Healthcare Providers in Your Insurance Network

While having insurance is great, it’s even better if you understand it and use it in the way in which it’s intended. A key aspect of health insurance is sticking to providers currently in your network. Sackett & Associates Insurance Services is here with a few tips on finding out whether a specific physician or provider is part of your coverage network. 

1. Touch Bases With Your Health Insurance Agent

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It’s best to err on the side of caution when it comes to your health and your healthcare coverage. If you’re confused as to whether a provider is a member of your network, simply contact your insurance provider and ask. Providers have specific tax ID numbers your carrier can look up for you. When you contact your agent, have the provider’s tax ID number and the type of health insurance plan you currently have. 

2. Call the Physician or Healthcare Provider

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You also have the option of calling up the provider’s office to see if they currently accept your specific brand of insurance. Here, it’s important to bring up the fact that medical practices don’t have blanket insurance acceptance. What that means is that all the physicians at the practice may not accept the same insurance policies. This is especially important to note if you ever have to see more than one physician at the same practice. Additionally, let the provider’s office know whether you have a marketplace insurance plan, because that type of plan may not be accepted.
 
As an added note, pair your doctor with the medical office or facility where you received care or plan to receive care. Some doctors operate out of multiple facilities. Your insurance carrier could have restrictions regarding the location in which you’re treated.

3. Do Some Research on Your Own

If you feel up to the task, you can do some online digging to see if you can find any information regarding whether your physician and insurance provider work together. To do this, log into your insurance account online. From there, see if there’s a “find your doctor” feature you can use. Even if you’ve seen a provider before that was part of your network, it’s a good idea to always double-check before returning to that provider. There’s a chance that specific facility or doctor was recently shuffled out of your network.

Seeing Out-of-Network Providers

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There could be a time when you have to visit a doctor who’s not part of your current network. Whether you’ll have to pay for your out-of-network visit depends on the type of insurance you have. For instance, PPO plans commonly take care of a percentage of your out-of-network visit. On the other hand, if you have an EPO or HMO plan, you will bear full responsibility for taking care of your visit. For out-of-network visits not covered by your plan, you can try to appeal the charge if you can successfully prove the visit was medically necessary and no one in your network handled the required medical care.
 
For more information on finding in-network providers, contact us online. Like us on Facebook, find us LinkedIn and subscribe to our blog.