In order to save on expenses, health insurance plans offer several different options with various network possibilities. The two most often discussed types of plans are:
· Health maintenance organizations or HMOs: These have closed networks of doctors that you can choose from when you need medical attention. HMOs do not offer benefits to policyholders when they decide to visit doctors outside the network. Instead those policyholders are expected to pay the entire expense of the visit to the out-of-network healthcare provider on their own.
· Preferred provider organizations or PPOs: These plans also have networks but they extend benefits to policyholders who want to visit physicians or medical facilities outside the network. Rather than paying a fixed price to the doctor outside the network, as they can with an in-network doctor, a PPO generally shares a percentage of the cost with the policyholder.
The decision to stay in-network or to go outside your network depends on several factors:
- Referrals: Sometimes when you need medical attention and you ask friends, family or other medical professionals for a referral, they refer you to a physician who is outside your network. If you feel more comfortable visiting this physician than one who's inside your network, it may be a good idea to do so.
- Family experience: If you have long-term experience dealing with a particular medical professional who is not in your new HMO’s network, it may be worth the additional expense to continue visits to that professional rather than finding a new doctor who operates within the network.
- Budget: If you can afford to see a doctor or visit a medical facility outside of your network and you’ve been referred to one or you have a long-term history with one, then it’s something you should consider.
The decision of what doctor to visit when you need assistance and what medical facilities to use is not just about your insurance plan. It’s about your budget and your personal comfort level with those professionals. If you find yourself wanting to go outside your network more often than not, you may need to explore some new options for health insurance plans that include these doctors within their networks.
If you want to start shopping for a new plan or have questions about the networks your favorite physicians are in, give us a call at 580-772-7101 or 1-800-878-7105. Magill Insurance is here to answer any and all of your Oklahoma Health Insurance questions. You can also visit our website to submit a quote.