Chapter 10Networks—Choosing Your Doctors and Medical Providers
Today's health insurance plans are dominated by the managed care model—for each plan, insurance companies maintain a list of doctors and facilities from which you can choose. This list is called the provider network. The provider network is the group of doctors, clinics, hospitals, and other medical sites covered by your health insurance. Different individual health insurance plans will provide you with different levels of coverage depending on whether you receive medical care inside or outside of the plan's provider network. For example, if you seek care outside of this provider network, your insurance may not pay for the services or may pay a lower amount. Health insurance companies want you to use the healthcare providers in their network for two reasons: (1) the providers meet the health plan's quality standards, and (2) the providers charge the health insurance company discounted rates for services provided to policyholders.
In general, a larger and more robust network will cost you more than a network that is limited to a smaller number of providers or a specific geographic region. It is vital for you to take ...
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