Understanding Health Insurance Networks

Health insurance can be a complex topic, and understanding specific critical details, such as how your network affects your coverage, is crucial. The team at Multiservices By Veronica Moreno is eager to offer its knowledge and assistance in summarizing what this part of your plan entails and why you need to understand it to optimize your health insurance costs.

What Is a Health Insurance Network?

A health insurance network can generally be considered a group of health care providers that have agreed to provide medical services for a health insurance plan’s members at prenegotiated rates. This network may consist of doctors, hospitals, pharmacies and other health care professionals and facilities. In most cases, when you visit a health care provider within your insurance network, the cost of services is typically lower than if you were to see a provider outside of your network.

Why Does Your Health Insurance Network Matter?

Your health insurance network may matter for several reasons. Consider the following:

• First, it can significantly impact the cost of your health care. If you visit a provider within your network, your out-of-pocket costs are usually lower. This is because insurance companies negotiate rates with providers in their network, often resulting in discounted prices.
• Second, some insurance plans may not cover services provided outside of their network, or they may cover a smaller portion of the cost. This may mean if you choose to see a provider outside of your network, you could be responsible for a larger portion, if not all, of the bill.
• Additionally, the size and composition of your network can affect the quality and accessibility of your care. For instance, a larger network may offer more choices and easier access to specialists.

How Does the Type of Health Insurance Plan You Have Affect Your Network?

The type of health insurance plan you have can greatly affect your network and how your coverage interacts with it. Consider how the following common types of policies treat services inside and outside of their respective networks:

• Health maintenance organization (HMO)—HMO plans typically only cover care provided within their network, except in cases of emergency. They often require referrals from a primary care physician to see a specialist.
• Preferred provider organization (PPO)—This type of health insurance policy can offer more flexibility and usually covers a portion of out-of-network care. However, in-network care is typically still less expensive.
• Exclusive provider organization (EPO)—These plans combine various elements of HMO and PPO plans. They often cover only in-network care but do not require referrals for specialists.
• Point of service (POS) plans—This form of health coverage typically requires referrals to specialists but covers some out-of-network care, especially if referred by your primary care physician.

We’re Here to Help

At Multiservices by Veronica Moreno, we are eager to help families, individuals and businesses understand health insurance networks and ensure optimal coverage. Visit our website or call 713-816-1809 to learn more.

This blog is intended for informational and educational use only. It is not exhaustive and should not be construed as legal advice. Please contact your insurance professional for further information.