How to Seek Network Medical Providers

Network providers are used by provider preferred organization (PPO), point of service (POS) and health maintenance organization (HMO) insurance plans. These types of insurance plans use a network of service providers that members are required to use in HMO and POS plans and are encouraged to use in PPO plans. By utilizing the services of an in-network provider, it ensures the benefits on the policy are used. If out-of-network providers are utilized, many times insurance companies place more responsibility to the patient than they would if a network provider is used.

Instructions

1. Call your insurance company to locate a network provider. You can locate the phone number for your insurance company on the back of your insurance card. Follow the prompts to speak to a representative. Notate the representatives name and request a call reference number at the start of the call. You may need to reference this information at a later date if there is a discrepancy with your bills.

2. Request a network provider in your desired zip code or town. If, for example, you are seeking an out-patient physical therapist to treat a sprained ankle, tell your representative that you are seeking a physical therapist for treatment. Be prepared with a pen and paper to write down names, addresses and phone numbers of service providers.

3. Request at least four different providers within your desired area. If you missed the spelling of a name or address, ask the representative to repeat herself so you can gather correct information.

4. Call the service provider and verify if they do participate with your insurance company's network. Request that the doctor's office verify your policy benefits before you schedule an appointment to be sure their office will receive payment for the services you seek.

Tips & Warnings

• There are some policies that do provide out of network benefits in which patients can receive services from doctors who do not have contracts with insurance companies. Out of network benefits generally carry a higher deductible and co-insurance rate over in network deductibles, copays and co-insurances. People tend to see an out of network provider if they want to see a very specific doctor or do not find any doctors in their network appealing.

• Make sure you are aware of your benefits before receiving treatment at a medical provider's office.

• Benefits are not fully guaranteed until the bill is received at the insurance company and the benefits are reviewed for the date of service that services were rendered.

References

• Physician's Care: Glossary of Words Defined