Jan. 20, 2015
This week’s Texas Medical
Association (TMA) “Hey, Doc” educational segment explains health insurance networks and how they influence patients’ ability
to pick a doctor to take care of them.
Health insurance plans’ “networks” are important to patients who buy insurance,
because they dictate which physicians and other health care providers the plan
“Hey, Doc” answers questions patients have about marketplace health insurance,
established by federal health system reform. Read on, for details.
will take care of me? What are networks?
plans in the marketplace must contract with doctors, hospitals, pharmacies, and
other providers to make sure patients have access to medical care. These are
the “networks” you keep hearing about.
you sign up for an insurance plan, you’ll be able to pick a doctor or hospital
from those networks to take care of you. But keep in mind that not all plans
have the same networks, and some of them might have only a few doctors and hospitals to choose from in
your area. So you’ll want to do some homework before you buy
insurance to make sure you can get the care you are looking for.
do I pick a doctor? Where can I find this information?
you shop for insurance at Healthcare.gov, each plan in the marketplace must
publish a directory of the doctors and hospitals in its network. Or if you
prefer a live person, you can call the marketplace hotline at (800) 318-2596,
and a representative should be able to help you with the application process so you can pick a doctor.
Some insurance companies have directories of their marketplace plans and
networks on their company websites, so you can check there, too. You can also
find phone numbers for the insurance companies on their websites.
remember: Not all plans have the same networks, and it varies by region, so you
might want to shop around to make sure you find a doctor or hospital that’s
right for you.
See each week’s “Hey, Doc”
Q&A and a lot more at texmed.org/Heydoc as well as in TMA’s patient
blog at MeAndMyDoctor.com. And TMA produced
“Hey, Doc” videos to help people understand how to navigate the marketplace.
TMA’s upcoming “Hey, Doc”
Jan. 28: Can I keep my
doctor or hospital when I sign up? How do I find out if my doctor is on my
insurance plan’s list? What should I do if I thought my doctor was included but
Feb. 4: Why is it important
that I pay my insurance premium on time? How do I know what kind of coverage I
have and if I can use my insurance?
Feb. 11: What is my marketplace
insurance ID card for? When can I receive my insurance subsidies?
TMA is the largest state medical society in the nation, representing more than 48,000 physician and medical student members. It is located in Austin and has 110 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.
phone: (512) 370-1381
cell: (512) 656-7320
phone: (512) 370-1382
cell: (512) 650-5336
Click here to follow TMA on Twitter. Or visit TMA on Facebook.
Check out MeAndMyDoctor.com for interesting and timely news on health care issues and policy.