It’s confusing, it can be pricey, and there are several household chores you’d rather do, than deal with it… It’s your health benefits. But don’t worry, you can do this. Consider this your health benefits 101.
What is a network provider?
Health insurance plans utilize networks. Networks consist of select network providers, which are hospital systems and the doctors and clinics associated with those systems. Network providers are sometimes called “preferred providers.”
Understanding which health care providers are in-network (in your health insurance carrier’s provider network) helps you control your out-of-pocket costs.
Why identify your network providers?
It may seem like a lot of work to go through all the trouble of verifying which hospitals, clinics, and doctors are your network providers for your health plan. Why bother? It’s smart to find a network provider because that's an easy way to control your health care costs.
The only time you can change your health plan is during your enrollment period. Most of the year, you can’t change it. But you can control how much you pay out of pocket all year long!
By using only your network providers, you can pay the lowest possible costs for health care.
Finding your network providers
A list of network providers is often available from your insurance company. However, it is important to always directly confirm with a provider that they are a network provider for your health plan before receiving services from that provider.
Unfortunately, you cannot always rely on network provider listings on the internet to be up-to-date. Just as you can change your job, a health care provider can change its arrangement with an insurance company.
An out-of-network provider can easily cost you double or triple the price for the same service from one of your network providers. The responsibility to make sure is yours alone. You may not want to bother, but the reality is that not confirming network providers could cost you thousands of dollars.
Health insurance plans and providers
Insurance carriers are able to negotiate lower costs by working with network providers, compared with an insurance carrier using more than one network provider. This saves money for you and your family by giving you the lowest rate.
Your health plan through your employer pays a portion of your health care bills. What you pay is called the “cost sharing” portion, usually less than your employer’s share. Specific amounts depend on your health plan. Copays, deductibles, coinsurance are all considered cost sharing.
Since health plan rates are negotiated, cost-sharing amounts are different for network providers and out-of-network providers. When making choices about your health care, pay attention to how much the cost sharing and out-of-pocket costs will be.
HMOs health plans are a less costly option, but one reason is that they allow services to be provided only by network providers (except for in true emergencies.)
PPO and POS health plans can be more expensive, but they allow you to use either network providers or providers outside the network. It’s your choice, but choosing out-of-network providers usually comes with a higher price.
Providers that may not have a particular Network:
- Mental Health services
- Ambulance (or other emergency transport service)
- Dialysis Centers
Ask questions especially when considering these types of services and providers! Confirm all providers' network affiliation before you go to an appointment.
Surgery and Emergency
Doctors often have surgical privileges in many different hospitals. If you or a family member is having surgery, make sure they admit you to an in-network surgical center (network provider) before the surgery. Be sure to confirm that the location and doctors are all in-network.
If you or a family member is in an emergency situation requiring transport to a medical facility, ask the ambulance to take you to a medical facility that you know is in-network for your health insurance plan.
Depending on the emergency situation, you may not get to choose. But if you have the chance to ask, do ask.
Giving the ambulance crew this information can be the difference between an expensive ambulance ride and a
not-as-expensive ambulance ride, so to speak! It depends on your health plan’s specific cost-sharing rules.
Ask more questions!
When in doubt about your Network Providers, ask questions! In fact, for any given health situation for you and your family, it is important to confirm all providers are network providers. This includes the individuals who treat you, as well as the location of the health care services. This will help you avoid unexpected expenses.
A good source is the administrative office of your provider. Health care providers are there to serve you and answer your questions about networks and health plan coverage. Often, your employer’s HR or Benefits department can answer general questions about your health plan as well.
Figuring out your health plan can be tricky. There can be a lot of information to deal with, especially when you are already concerned about a health matter. But, the more general concepts you know, the better equipped you’ll be. You can make educated choices!
Empower yourself to proceed confidently when making decisions about health care coverage for you and your family. Health Benefits 101 can help you understand the basics. Recognize your needs and know your health plan. It can really help you know what to expect and how to deal with it.
But wait, there’s more. This is a general description of a Network Provider, but that doesn’t cover everything about your plan. Check your Summary Plan Description (SPD) from your health insurance company. It contains what you need to know about the specific rules of your health plan.
If you want to know about any plans or services we provide, please access your Employee Benefits Corporation plan’s Summary Plan Description (SPD) and other helpful information by logging in. Just click the “Log In” button in the upper right corner of this page, then “Participants.” There you will find the specific rules for your BESTflexSM health care flexible spending account (FSA), EBC HRA health reimbursement arrangement (HRA), or SimplyHSA health savings account (HSA). These benefits give you ways to save money pre-tax on your health care expenses.
You can also log in to access helpful information about your CommuteEase pre-tax parking and transit benefits, as well as information for those who use COBRASecure! Not sure what plans you have? You can log in at the top of the page (www.ebcflex.com) to see all your current plans, or ask your employer.