Insurance Blues, Part 3: Networks

October 27, 2016

This is the third post in a series on Health Insurance Basics.  Open enrollment begins in less than a week, and many people will be picking a new health insurance plan for 2017.  One of the most important things to understand is Networks.

 

 

 

Network:

 

 

There are many types of networks:  data networks, computer networks, neural networks, and insurance networks.  Insurance networks are becoming more important every year.

 

One impact of the ACA (affordable care act) is that insurance policies from different carriers are now much more homogeneous.  All plans must cover the same 10 essential health benefits.  All silver plans are going to be similar, all bronze plans are going to be similar, and all HSA/HDHP plans are going to be similar.

 

Networks are one way companies differentiate themselves from their competitors.   A network is the doctors, healthcare providers, clinics, and hospitals that have contracted with an insurance company to provide services and supplies to the plan’s members.  A provider who has not contracted with the company is considered out-of-network.  This relationship can change from year to year, or from plan to plan within a company.

 

Different networks cover different doctors, hospitals, and facilities.  Some plans will cover services even if you don’t stay in your network, other plans make you pay for all out-of-network services.  One important way to decide on an insurance company or plan is to look at their network.  Does it fit with your health care needs and preferred doctors?

 

Things to think about for 2017:

 

DO NOT assume that your network is the same, even if you are staying with the same carrier.  A good example in King county is Premera.  For 2017, all individual plans in King county use a designated partner system for their network.  Options are:  EvergreenHealth Partners, MultiCare Connected Care, Northwest Physicians Network, UW Medicine Accountable Care Network, and Virginia Mason Medical Center.  Not all doctors accept these new plans, and if you have doctors in multiple networks, you may want to consider a different company.

 

Do you really need a large network?  Large networks are nice, but are you paying for a potential need rather than an actual need?  If you only go to the doctor once a year for your annual exam, you could consider a plan with a small network that includes your current physician.

 

When was the last time you went to see that doctor?  Are you paying for access to a doctor you rarely see?  It may make more sense to buy a plan with a smaller network and pay out of pocket to see that random doctor if the need arises.  For instance, assume you could save $50 a month by picking a smaller network.  That’s a fixed savings of $600 per year.  If your chiropractor is out of network, but you see him once every six months, it makes sense to pay him $100 cash for an out-of-network visit, and save $500 in premiums.   If you don’t go see him one year, you save even more.

 

Does your plan cover children who are attending college out of the region/state?  Double check your coverage.  In many situations it makes more sense to purchase a plan in the area/state that your child is currently residing.  Even going from Seattle to Spokane could make a difference.  Does the school have a student medical plan available?  In most cases normal doctor’s appointments will not be covered at the in-network rate.  This may be acceptable for some situations, but if your child has a chronic illness or sees a doctor more than just once a year, it would be wise to explore local options.

 

But what if you have an Emergency? You do not have to go to an in-network emergency room for your care.  Emergencies are treated as in-network care.  If you are in an accident the ambulance doesn’t stop to ask your hospital preference.  You go where they take you.  But if it’s not an emergency, you should go to your normal provider, clinic, or hospital. 

 

Still have questions about your plan’s network?  Give us a call.  We can help you evaluate your network to make sure that your doctors and providers are still covered in 2017.

 

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