The facilities, providers, and suppliers your health insurer or plan has contracted with to provide health care services. Every health insurance company has a different network. The contracts are different with each provider and facility, and it is very important to understand this.
You can find a link of a list of providers in each plans network in the plan description in your Marketplace account for individual coverage. If you are on a group plan you can find this information by going to the health insurance companies website, and there also should be a link included in the SBC (Summary of Benefits and Coverage). If you are not able to find this information, you can always reach out to your provider and ask them directly.
Insurance companies may have different networks for different plans, so make sure you are searching the provider network of each specific plan you compare. Narrow networks have become much more popular over the years and the reason they have become more popular is because the cost of the plan is typically cheaper. Medica with CHI Health is one plan in particular that has become very popular in Central Nebraska. If you elect this plan, you will receive lower premiums, but it also restricts you to receiving care at a CHI facility.
First off, make sure your primary care physician is in network. I would say this is the most important thing to consider. No one wants to switch primary care physicians, especially for kids or for someone who has an ongoing medical condition. Second, make a list of providers that you and your family use. Providers will include health care professionals, like doctors, physical therapists, or psychologists. Then make a list of health care facilities you and your family utilize. Heath care facilities can include hospitals, urgent care clinics, or pharmacies. Both of these items are extremely important and it becomes even more important when you live in an area where there is not a large selection of providers to choose from.
I had an individual that went in to get her annual bloodwork done. She looked up to make sure the hospital was in network because it was a newer hospital. After the bloodwork was completed, it was then sent off to the lab at the hospital. This individual received a bill in the mail a few weeks later that stated she owed x amount of dollars for the lab work. This was a preventative visit and under her plan it should have been paid at 100%. At first, I assumed that this was a billing error (which happens all the time). 25% of all healthcare is wasted and the majority of that wasted care comes from billing errors. I came to find out after digging into this, that the lab was out of network. How would this individual ever have known that the lab where her bloodwork was being sent which was in the same hospital was considered “out of network”? This is just one example that highlights the importance of double checking who is in network and who is out of network when it comes to any healthcare service.
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