How Can I Verify if a Provider is in My Coverage Network?

This weekly Q & A addresses questions from real patients about healthcare costs. Have a question you ’ d like to see answered ? Submit it to AskChristina @ .


My employer recently switched my health policy coverage from Blue Cross Blue Shield to Aetna. I called my sophisticate ’ south office to make certain they were in my new network, and they said that any Aetna design would be ticket. But on the Aetna web site, the provider search tool didn ’ t list my doctor. How can I know for certain that my doctor of the church ’ s visit will be covered as in-network concern ?


Your caution is admirably. Going to a doctor within your policy plan ’ randomness network helps ensure you ’ re getting the most out of your policy and minimizes your cost-sharing expenses. unfortunately, many people find themselves with unexpectedly large checkup bills after seeing a doctor of the church they believed was in-network, but was n’t.

Same carrier, different plan, different network
policy companies build their design offerings by inviting doctors to join their networks. When you visit a doctor who is in-network, you benefit from the negotiate payment rates the insurance design and doctor have agreed upon. It ’ mho these rates that translate into lower costs for you when you go in-network .

Knowing for sealed which doctors are separate of your network international relations and security network ’ triiodothyronine constantly dim-witted. Just because a provider accepts your indemnity or is part of some Aetna networks doesn ’ thymine mean that he or she is in-network for your specific design .
There are many ways insurance companies are able to offer plans at a kind of price points. Network size is one cost-control method. Carriers like Aetna typically offer several different policies with subtle differences in their networks. Plans with lower premiums, for case, much have smaller or “ narrower ” networks .
Websites aren ’ t always up-to-date
policy companies broadly have provider search functions on their websites, allowing customers to find doctors that are in-network for their plans. Networks change by the day, however, so the supplier database may not be wholly up-to-date when you ’ ra research. sometimes the doctor ’ s aesculapian group, but not individual supplier names, is listed as in-network. thus when you try to search for your specific supplier, she might not show up — even if she ’ randomness in-network .

Your doctor ’ s web site might besides list the insurance plans honored. The doctor may identical good accept Aetna insurance, and even be separate of some networks under Aetna plans. however, that repair could placid be out-of-network for your specific policy.

Call your provider. Call your policy. Verify everything .
You did the correctly thing by calling your doctor ’ mho function and using Aetna ’ s provider search tool. Follow up by calling your indemnity party to verify whether your provider is covered under your plan. But first, give your doctor ’ mho agency another call and necessitate for its tax designation number .
When you call your indemnity supplier, use your sophisticate ’ randomness tax ID number to clarify which aesculapian supplier you ’ re inquiring about and have your design information handy. Make sure you ask whether the medical provider is in your network, not just whether the repair is covered by Aetna indemnity .
You ’ ll want to document your insurance customer representative ’ mho name and designation count, and ask that verification of your in-network coverage be sent to you in writing. This information could save you perturb if your doctor ’ second visit results in an unexpected bill and you have to file an solicitation .
If your doctor is not within your provider network, it ’ ll be up to you to decide whether to stick with your repair and have greater out-of-pocket costs or find an in-network supplier. If you decide to stay with your out-of-network provider, consider negotiating cash prices with your doctor to minimize what you ’ ll owe .
Tips on finding a fresh doctor
Some people would preferably pay more to stay with a current doctor of the church. If that ’ s the character for you, find out what your out-of-network costs will be .
If you ’ ra switching providers to save on medical costs, but were differently pleased with your doctor, ask for recommendations. Your doctor may be able to direct you to a colleague with a exchangeable approach path. Talk to friends and family, excessively. Websites like Medicare ’ randomness Physician Compare and Healthgrades can besides provide feedback on specific doctors, and Yelp can be an excellent beginning for detail reviews.

Most importantly, when choosing a new doctor, go through the steps mentioned above to confirm the repair is in-network. Depending on your design ’ randomness network size, it may make sense to start your search on the Aetna web site. That way, you ’ ll save yourself from choosing multiple doctors only to find out they aren ’ thymine part of the net .
If you unwittingly are treated by an out-of-network doctor of the church, you ’ ll be stuck with a significantly higher bill than you would with an in-network doctor. A little ascribable application before making your following appointment can save you a considerable total in out-of-pocket costs .

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Category : Finance

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