Choosing a health plan is not as easy as it once was. Of course, the costs, coverage, and out-of-pocket maximum are important, but just as important are the doctors and hospitals included in the provider network. So, before you enroll in a plan, make sure you’re not trading off the doctors and hospitals you trust for copayments that seem too good to be true.

Check the latest info

Most people only look at their provider directories to see which doctors participate with the plan they're considering. It’s a good idea to take it one step further and call their office to see if they still accept the plan, even if they’re listed in the provider directory because there’s a chance it may not be up-to-date. That’s important information to know, because unless it’s an emergency, some plans may not cover your care if you see providers who aren’t part of the network. Usually the provider information on health plans’ websites is more current than what’s listed in the paper directories that come in the sales packet.

Which hospitals are included?

Besides doctors, provider directories also include a list of hospitals, but if they are listed under the “Emergency Services” section, keep looking to see what hospitals are part of the health plan’s network for non-emergency care. All hospitals in Florida are required to see you for an emergency, regardless of your insurance, so just because the hospital you like is listed for emergency care, it doesn’t mean your plan will cover non-emergency care there. Most people rarely need emergency care—it’s much more likely they’ll need services like a knee replacement or cataract surgery.

But if the hospital you trust is not in the provider network for non-emergency care, you may be forced to get your healthcare from a hospital you’re not comfortable with and don’t want to use. So, make sure the hospitals, surgery centers, and other facilities you trust are part of your plan’s network for those non-emergency situations. A good provider network will include a choice of several facilities conveniently located in your area. Unless you need highly specialized care, you shouldn’t have to drive to another county to see a participating provider.

Credentials matter

Also, health plans with contracted provider networks have already verified their providers are properly licensed and qualified to perform the services they offer. Participation requirements vary among health plans, so check the provider directory to make sure the doctors are board certified in their specialty and the hospitals are accredited. Board-certified doctors have met educational requirements and passed rigorous testing in their field, and accredited hospitals meet high quality standards for things like patient rights, medication safety, infection control, and outcomes.

Sometimes if a health plan has a limited choice of doctors or other providers, it can be a warning sign that they have a difficult time working with that health plan. It could mean important services aren’t usually covered, claims aren’t paid quickly, or authorizations are complicated or rarely approved. No one likes the high cost of healthcare these days—but your policy could be a waste of money if you can’t get the services you need from the doctors and hospitals you want.

Whether it’s for your house, your car, or your health, the purpose of insurance is to protect you from catastrophic financial losses. We don’t like to think about the day we may suffer a serious injury or illness, but the truth is it can happen when we least expect it. Therefore, it’s important to do as much research as you can when you're choosing a plan.

June 2010

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