A provider network is a group of doctors, hospitals, pharmacies, and other health care providers that have agreements with a health insurance plan.
Using an in-network provider can often reduce your costs.
Different plan types have different network rules.
For example:
HMO
Health Maintenance Organization plans generally limit coverage to providers in the plan’s network, except in certain situations such as emergencies.
PPO
Preferred Provider Organization plans generally allow you to use both in-network and out-of-network providers, although you typically pay less when using in-network providers.
EPO
Exclusive Provider Organization plans generally cover care within the plan’s network except in certain circumstances, such as emergencies.
POS
Point of Service plans combine features of different managed-care arrangements and may require referrals for certain specialist care.
The exact rules depend on the plan
Leave a Reply