Two Things Every Insured Employee Should Know

Hi Bud,
I recently starting offering my employees health insurance for the first time (and I’ve got to say, it feels pretty great to do that). But since this is a space I’ve not had experience in before, I don’t feel too confident in how to answer questions I’m getting from my employees.
I’ve read your column before, so I thought I’d toss this one your way — the most common question I am getting (and am curious to know myself) is how to know which providers are in our network?
Thanks for the help,
Stumblingto Teach Employees (about) Providers & Healthcare

Hi S.T.E.P.H.,

Over the many years I’ve been an insurance broker I wish I had a nickel for every time I’ve been asked if a particular Doctor or Hospital is in a particular network. I’d be a wealthy man!
There are many important aspects of each health plan which we’ve discussed in the past. One of the most important that we haven’t spent a lot of time on is the Provider Network of the PPO, EPO, POS or HMO of the network you’re covered on.
An important task for each insured employee during Open Enrollment is to investigate the Provider Network of the plan they are interested in. The first step is to determine the insurance company, name of the network and the search tool to be used to exercise who is in the network and who is not. If any of those 3 criteria are not evident to you, I’d suggest reaching out to your insurance broker to clear things up.

Here are a few handy do’s and don’ts to know about Provider Networks:

• DON’T rely on printed and dated Provider Directories. These printed directories are out of date the moment they are printed.
• DO call and verify the Provider is STILL in the particular network by asking the following question: “Is Doctor BLANK still a contracted physician in the XYZ Network of ABC Insurance carrier?” If you simply ask “Do you guys see Aetna patients?” you’re going to be disappointed after you get billed for the Out-of-Network visit.
• DO spend some time now getting familiar with how to use your carrier’s Provider search tool. Almost all major carriers have Provider search info on the front page of their website.

Insurance carriers have dozens and dozens of networks. Some of the networks are developed from their own resources and others they simply pay an access fee to rent or use.  Most networks lean towards being defined by local geography, but many are nation-wide and have thousands of providers and hospitals. When the employee population is dispersed across several states these broad national networks are the correct choice.

• DO verify the network you’re considering, verify the doctor you intend to use has admitting privileges’ at the hospital you would typically use and then re-verify before each visit. This prevents you from being charged for Out-of-Network fees associated with seeing a Provider.

Obviously, there are times, emergencies for instance when you don’t have time to verify and many time carriers will waive Out-of-Network charges in life threatening situations. Check your policy. The bottom line is this: It is the patient’s responsibility to select the Provider they utilize. Having a plan ahead of time and verifying your plan includes this Network and this particular Provider can save you trouble in the long-run.

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