A physician may be insured with an HMO or another plan. In a HMO, you must get a referral to see a specialist. You can see specialists within the HMO’s network or outside of it. If you use an outside provider, you will be responsible for filing a claim for the services you received. The health plans of your doctor are the most important part of your coverage. A physician may not be insured with the same health insurance plan as you, so you should be sure to research your plan carefully before visiting a doctor.
The level of treatment that a physician provides is determined by the type of health insurance the patient has. Some insurance companies negotiate a lower rate for doctors in their networks. Other health insurers require the patient to pay for services if the doctor is out-of-network. If you have an HMO or PPO plan, ask your doctor about their prices. Most doctors in networks have lower rates than their non-network counterparts.
Managed care plans often have rules that govern what services a doctor can provide and where they can provide it. While some doctors’ offices are helpful in navigating this, many people prefer to contact their health insurance provider directly to determine if they qualify for their coverage. Insurers sometimes refuse to speak with insured members but persistance can pay off. They may be able to provide you with more information about your coverage.