What Are Network Health Insurance Plans?

Many, of not most, health insurance in the US today uses a plan network. This network is made up of various medical providers, like doctors, hospitals, and even pharmacies, that agree to abide by network rules. Insurers use these organizations to control costs and make it easier for consumers to make claims. Do you have a network medical plan? Are you considering one in the future? It is important to understand how networks work so you can make good use of your coverage and make wise decisions.

Consumers get to enjoy the advantages of belonging to a network medical plan, but they may have to give up some flexibility. If you belong to an HMO, for example, you almost always have to use the plan's network in order to get your medical services covered! If you belong to a PPO, you will get the lowest prices if you stay within the plan network though you may still get covered if you step outside the network.

Insurers will impose rules upon organization members. These may include a variety of different things, but let me list some common ones.

  • The network will have guidelines for the amount a provider can charge for s certain service.
  • The network may even impose some recommendations about which treatments and services are covered.
  • The network may impose claims and billing rules on health providers. For example, health insurance plans that offer a doctor's visit co-payment will require organization providers to only require the co-payment and wait for full payment from the insurer.

Is A Network Medical Plan Right For You?

Network medical plans are very popular today because they tend to make health costs cheaper for consumers. They also make it a lot easier to access services because consumers usually do not have to bother with claims. It is all documented and submitted by the health care provider. Some people would rather have a policy with less restrictions, and they enjoy the flexibility of another type of plan though.