What is a health plan network?
A health plan network is the group of health care providers (doctors, psychologists, physical therapists, etc.) and facilities (hospitals, urgent care clinics, pharmacies, etc.) that a plan has a contract with to serve its members. These providers are known as network providers or in-network providers. A provider that isn’t included in the plan’s contract is an out-of-network provider.
By choosing providers who have a contract with the insurance company to provide medical products and services, you get to take advantage of pre-negotiated, often discounted, rates. Each Blue Cross NC health plan has its own network of covered health care providers. The larger the network, the more in-network options you have for doctors, hospitals and other facilities. But plans with a larger network usually have a higher monthly premium. Plans with a specific health system network are often less expensive and help you get coordinated care, but usually only the doctors and facilities of one major health system are in-network.
How to choose a health plan
Did you know that out-of-network charges are one of the biggest reasons for high medical bills? When choosing a plan or getting care, network coverage should be one of your top concerns. It’s important for you to weigh access versus cost when deciding on a plan. While some plans do offer out-of-network coverage, you can save the most money by only seeing providers that are in your plan’s network.
Before switching to a health insurance plan with a new network, make sure it will still offer the coverage you need. This includes checking to see if any existing providers and facilities that you want to maintain are still considered in-network under the new plan. It is recommended that you list out all your providers, facilities and medications to ensure everything will be covered before making a switch.
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