Navigating the System

Empower yourself as a patient, and learn how to get the most out of your benefits. Each plan is different, so this section of our guide will help you understand what it is that you should look for when you receive your insurance information.  This section will help you navigate the health care system when you need care.

Topic Area:Provider networks and referrals

No, you are responsible to check if a provider is in your network. Every insurance company has different benefit plans and network requirements. It is also common for healthcare providers to move in and out of different health plan networks, making it hard for your doctor to know what providers are included your network. However, your provider’s office will often help you by contacting the insurance company to make sure the referral is in your network. Ask your provider for assistance if you receive a referral.

If your doctor refers you to another healthcare provider check to see if that provider is in your network before you receive care. You can review your plan information, visit your insurance company's website, or call your insurance company customer service with questions. Consider calling the provider’s office in advance to confirm they are part of your insurance plan network. Even if the provider is included on the insurance plan’s web site, this information can be outdated. You can confirm that the provider accepts your plan by contacting their office directly or the insurance plan customer service.

Remember, if you see a provider who is outside of your network, you will typically pay a higher percent of the cost. Take the time to know who is an in-network provider or an out-of-network provider and know what you will be responsible to pay.

Staying in-network will help you avoid unexpected costs. When in doubt, check with your insurance plan.

4/19/2018

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