Check Provider Networks Before You Buy

What is a Provider Network?

You might know that copays, premiums and deductibles are important things to consider when selecting the best health insurance plan for you. But did you know that a health plan’s provider network should also be an important factor in your decision? Before you compare health insurance plans, keep reading and learn what to look for besides price.

Health plans use select groups of doctors, hospitals and other health care professionals who work together to provide a full range of covered health care networks. Plans with smaller networks may have lower monthly premiums than plans with larger networks, but this also means that smaller networks limit your options for which doctors are available under that plan. Some plans’ provider networks have fewer doctors and hospitals than others.

Here are some tips to keep costs low when using your plan. You’ll want to make sure you stay “in network,” which means using the doctors and other health care providers that are in the plan’s network you selected. If you visit a doctor outside of your network, you may have to pay more for your health care. This is what is called an “out-of-pocket cost.” In some cases (such as HMO plans), you may have to pay the full cost when you go out of network. When you compare health insurance plans to check that doctors, specialists, hospitals and urgent care centers are in your plan’s network before you buy a health plan, it can help you better control your expenses when you or your family receive care.

Tip: For our health insurance plans, use the BCBSNM Provider Finder® online to see what doctors, hospitals and urgent care centers are in network for the plan you are considering to buy. Provider Finder is also the place to go to check for doctors or any specialists you need to see after you have coverage.


Provider Networks: HMO vs PPO

The two most common health plan networks are PPOs and HMOs -- there are other networks as well. In a PPO plan, you may pay a higher premium but have greater freedom to choose doctors and hospitals and do not need referrals. An HMO may have lower monthly premiums, but your Primary Care Physician will coordinate your care within the network and a referral is required to see a specialist. 

Because this can be a big factor in your medical visits, here are some questions to ask yourself as you select your health plan:

  • Have I checked to see if my frequently-visited doctor, specialists, hospitals or urgent care centers are in the plan’s network that I selected?
  • How important is it that I have a lot of doctors and hospitals to choose from?
  • Am I okay with paying a higher monthly premium to potentially have more provider choices?

Still needing some help? Below are some examples to help give you a better understanding:

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