The Guide

Family Health Insurance

Consider Using Participating Health Care Providers

The policy details for your family health insurance plan will also clearly define the difference in benefits levels, deductibles and coinsurance between using participating providers and out-of-network providers. HMO plans will limit you to medical care from your primary care physician and his medical group. Most PPO plans will give you a choice of going to any physician you want, but the physicians that are part of the insurance company's network are the doctors that the insurance company prefer you use. These in-network participating providers are on contract with the insurance company to provide services at pre-determined negotiated rates. When you use these in-network providers, the cost to the insurance company is reduced and the benefit from the savings received by the insurance company is passed on to you.

Advantages of Using In-Network Providers

When your family uses in-network providers you will often have lower co-payments, deductibles, and coinsurance and share-of-costs based on the negotiated rates. You should request a provider directory from you health insurance carrier. This is a list of all doctor's and health care facilities within your geographical location that are contracted with your insurance company. Most insurance companies also offer online provider directories that are usually easier to use and more up-to-date. You can search these directories by location, specialty type or name. You may also contact your insurance company for assistance in finding a physician or specialist.

If you use out-of-network physicians, you will usually pay a higher coinsurance and will not benefit from the negotiated rates offered through participating providers. There may also be maximum benefit limits for out-of-network services. You will also be responsible for paying excess charges over the "usual, customary and reasonable" rates for the services that were provided to you. The insurance company will only pay their percentage on the fees that they deem to be reasonable. If you must use out-of-network providers, always inquire about their fees in advance and check with your insurance company for an estimate of how much they will pay toward the services provided. Compare those to your costs when using an in-network provider. You may be surprised at the difference in your share of costs and will likely be motivated to stick with in-network providers for future medical treatment.

Note: The information and advice provided in this Guide to Family Health Insurance may not provide the best advice for every situation. The best options for your family's medical insurance may be unique and require the advice of a local advisor. We highly recommend that you consult with more than one insurance broker in your state to gather and compare alternative opinions. The owners of HealthInsuranceFinders.com are not responsible for any decisions you make in regards to your family's health insurance through the information provided in this guide.

 

 

 

 

 

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