How Healthy Is Your Health Care Provider Network? | HealthyWomen

For an increasing number of Americans, having health insurance may not be enough to guarantee coverage and access to care when you need it most. Narrowing provider networks may prevent you from being able to see the appropriate provider to treat a medical condition or to maintain your health.

All provider networks are not created equal, however. If too narrow, a network can result in low quality care, lack of access to care, and/or higher prices for out-of-network providers."Network provider adequacy" judges networks on their ability to accommodate patients with a sufficient number of primary care physicians, specialists, hospitals, and more.

Nevertheless, these standards are not be enough to protect you as a health care consumer. Even with these laws, a managed care plan can create additional rules to restrict access. One such policy common among payers is to ensure a provider is available within a certain mileage radius . Policies such as this can create health care disparities and other challenges particularly for those patients living in rural communities as well as as lower-income or elderly patients.

That requirement might not have been a big deal in Texas because I had a car and most miles are highway miles. However, 30 miles in the Washington, DC, area is not a reasonable radius for a daily commute to a fitness center. For reasons such as this most gyms and fitness centers have forgone these draconian policies and now promote flexible month-to-month agreements.

The only way to know is to ask. Do not be afraid to contact your health plan and your providers, including primary care physicians and specialists, to find out if they are in your network—and if not, why not, so you can make an educated choice in selecting the type of health care coverage that suits your needs.

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