Health Insurance Blog

Doctor Networks Uncovered

Your key to understanding how Doctor Networks work and how to make them work for you

First of all, can we say Happy Chinese New Year!!!

Ok, now to get back on topic…

Health Insurance can be so confusing.  There are many in’s and out’s that people try to keep track of.  One of the questions we get a lot is “How come my doctor isn’t In Network? Or How can he get in my Network?”  Our clients want to know why the heck they can’t go see the doctor they have always gone to, or a new one that they heard was awesome.  Well that is a very good question.  You don’t want to go see someone out of network, because most health insurance plans cost you a butt-load more to see someone off network even if they provide you exactly the same treatment. So if you have a new plan, or if you want to see a new doctor, you will likely run into this situation.

So here is your key to understanding how Doctor Networks work and how to make them work for you.

Tim did an awesome video on this subject, so if you want to stop reading, just watch the video!

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First off let me explain—what is a Doctor Network?

Basically a Doctor Network is a list of doctors that are included in your health insurance plan.  Each carrier/plan has a Different Network that they offer.  So you need to go see doctors in the network included in your plan in order to keep your costs more affordable.

Doctor Networks to Doctors/Physicians is actually an advertisement or marketing piece for the doctor.  Instead of marketing through TV or another way, the doctors market through the health insurance carrier and then the carriers send their customers to go see those doctors which are within the networks.  This is how they obtain new clients and retain the clients they already have.  So doctors contract with health insurance carriers to become part of their networks.

Sounds simple enough.  So why wouldn’t every doctor in the area want to be covered by all the networks?

There are 3 pain things that come down to why a doctor would want to be on a particular network:

1) Does the insurance company allow for an open panel of doctors?  Or in other words, is it open to new doctors getting on the plan included in that network.  If the carrier isn’t willing to add them to the network, they really have no choice.

2) Is the doctor willing to accept the contract amount of pay from that insurance company? Obviously different carriers have different agreements with the doctor’s on their network.  If the doctor doesn’t want to agree with the terms of that carrier, they will go with another carrier with better incentives for being part of their network.

3) Is it an over-saturated market? Are there too many of those particular kinds of doctors in that area?  Neither the Doctor nor the Carrier will want to have an excessive number of physicians of the same skill set on any particular network.  That would not benefit either party as using the network as an advertising piece.

There are of course other considerations, however this covers a few of them.  If you really want to see a doctor that isn’t in your network, you may consider changing to a health insurance plan that includes that doctor next time you enroll in a health insurance policy.

Always check with your health insurance company to make sure that the doctor you are wanting to go see is in your network BEFORE you go see that doctor.  This is very important because if you go to see a doctor that is not in your network, most plans will charge you significantly more money than if you were to go see a doctor that is in network on your plan.

This blog was written by Tim and Marissa.  Images produced from Canva.com

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