Have you noticed that different health plans have different rules about the doctors you’re allowed to see? For example, some health plans require you to receive care only from “in-network” doctors, while others allow you to visit health care providers outside the heath plan’s network and even see specialists without a referral.
If you’re looking to purchase a health plan, these differences should be a major factor in your decision. It’s important to understand each plan’s rules and compare your network options to find the right balance of cost and flexibility for you.
Cost versus choice
A provider network is made up of doctors, clinics, hospitals, and other health care professionals that a health plan contracts with to offer medical services to members at reduced costs. The type of plan and provider network you choose are important because they determine your access to medical providers and how much you’ll pay out of your own pocket each time you receive care.
For example, an HMO (health maintenance organization) plan requires members to receive care only from providers within its network. A PPO (preferred provider organization) plan allows members to choose any doctor or hospital they wish, but the plan will pay a greater portion of the costs when care is received from providers within the network. Yet another type of plan, called the point-of-service (POS) plan, combines aspects of both HMO and PPO plans.
Many health plans offer a choice of networks. As an example, the WPS Individual Preferred and Health Savings Account (HSA) plans are PPO plans that offer network options from lower-cost, local networks to an expansive (and more expensive) Statewide Network that includes access to providers nationwide.
Do you have a question about provider networks or any other health insurance topic? Leave a comment below and we’ll answer your question, either here or in a future blog post.