How Provider Networks Work

Annual Enrollment Period is almost over! When we meet with our clients, we often ask them for a list of their doctors and specialists when we look at other plans. The reason we ask for this is that if we recommend you change your current plan, we want to make sure they are in the plan’s provider network. What’s a provider network? A provider network is a list of the doctors, other health care providers, and hospitals that the insurance company has contracted with to provide medical care to our members. These providers are called “network providers” or “in-network providers.” A provider that hasn’t contracted to participate in a FHCP network is called an “out-of-network provider.”

Depending on the type of plan you buy, your care may be covered only when you see a network provider. You may not be covered, or have to pay more, and/or get a referral if you choose to get care from a provider who isn’t in your plan’s network. Why do some plans cover benefits and services from network providers, but not out-of-network providers?

When a provider is a network provider for a plan, it means that the provider agreed to provide benefits or services to the plan’s members at prices that the provider and the plan agreed on. The provider generally provides a covered benefit at a lower cost to the plan and the plan’s members than if providing the same benefit to someone without insurance, or someone with insurance through a plan in which the provider is out-of-network.

Do not be complacent with your current insurance! A short conversation with a broker could save you a lot of money next year. There are 6 days left of AEP to make a change. Book a meeting with an agent today!