What are health insurance provider networks?

You need to be familiar with the insurance plan's provider network in order to make informed decisions about medical care. The out-of-pocket cost will be less if care comes from a provider in the network. You will pay more, and may need a referral if you go outside the network.

Many health plans use provider networks. PPOs (Preferred Provider Organization) typically allow out-of-network providers without referrals, but the individual pays more out-of-pocket. POS (Point of Service) Plans require referrals for out-of-network providers, and shift more out-of-pocket cost to the individual. You can see an out-of-network provider with an HMO (Health Maintenance Organization) plan, but the individual may pay the entire cost of medical services. An EPO (Exclusive Provider Organization) requires in-network care except in an emergency.

Identify your health care needs before shopping for individual health coverage. Insurance plans must identify he health care professionals and medical facilities in their provider network up front. Compare your list of providers to the insurance plan's network. Be sure the policy covers the medical professionals and health care facilities that will be taking care of you.