OREANDA-NEWS. September 29, 2015. Choosing a health plan? Don’t miss doing one very important fact check: Are the doctors, hospitals and pharmacies you want to use in that plan’s network?  If not, your first bill could be a nasty surprise.

But, you say, my doctor accepted a plan from that insurer this year, so he’s in network, right? Not necessarily. Insurers can have different networks for different plans and they can change from year to year. Your doctor may not be in the specific plan you’re considering for next year.

Going to a doctor, hospital or pharmacy outside your plan’s network almost always costs you more – sometimes a lot more — unless it’s an emergency.

Make sure. Otherwise, you’ll likely pay a lot more if you go to a doctor, hospital or ambulatory care center that’s not in the plan’s network. You might even have to pay the whole bill, depending on your plan. That’s a surprise you can do without.

Your other choice would be to change doctors, or go to a different hospital or pharmacy. If you don’t already have a strong relationship with one doctor, then the new plan and its network might be a great choice for you.

Smaller networks can be better

More health plans today have smaller, more focused networks. In fact, half of the networks in plans offered on the public health care exchanges last year were “narrowed.” That can be good. The doctors and hospitals in those plans have generally agreed to charge less. That means you may pay less – less for premiums and less when you get care.

Some plan networks are built around a health care system of doctors and hospitals that are making a coordinated effort to keep patients healthier and costs under control.

These newer kinds of plans can save you money and give you quality care at the same time. But if you want to keep seeing the doctor you know, or keep going to the closest hospital, make sure you confirm what plan(s) they are in. Some prescription drug plans also have smaller networks, which helps to keep costs down. If it’s important to you to use a specific pharmacy, make sure you check out the drug plan’s network as well. Some plan networks are built around a health care system of doctors and hospitals that are making a coordinated effort to keep patients healthier (what’s called accountable care organizations). Some health care systems even offer their own health insurance plans. In these plans you usually will pay more to see a doctor who’s not part of the health care system.

Check the network before you buy the plan

First, make a list of any doctors you know you want to see. Include hospitals, ambulatory care centers or pharmacies if there is one you particularly want to use.

Then, do one of these:

  • Look on the insurer’s website for its list of doctors and hospitals (or pharmacies if it’s a drug plan). First choose the specific plan you’re interested in. Then look up the doctors on your list. (For example, if you go to Aetna’s online directory, you first choose the type of medical plan, then your state, then the specific plan name. Only then do you look up a doctor.)
  • Or, if you are choosing from among plans offered by an employer, your enrollment materials may include a link to that plan’s network listing.
  • If a website’s online listing doesn’t let you choose a specific plan, don’t just assume all the doctors listed are in every plan. Call or e-mail the health plan. Ask if your doctor or hospital is included in the specific plan you’re considering.

Out of network means more money out of your wallet

Remember that health care networks help keep your costs down. Going to a doctor, hospital or pharmacy outside your plan’s network almost always costs you more – sometimes a lot more — unless it’s an emergency. Some plans won’t pay anything if you choose an out-of-network doctor or hospital. Plus, money you spend outside the plan’s network may not count toward your deductible – the amount you have to pay on your own each year before your plan starts to pay part or all of the cost of care.

What if the plan you want doesn’t have the doctors you want?

Check your other plan options. Is your doctor available in a plan that costs you more, or has a higher deductible? You may be willing to pay more to keep the same doctors. Or, you may decide that there are quality doctors, hospitals and pharmacies available in the first plan, and make that choice.

Just be sure to have all the information you need before you choose, it’s the best way to avoid an unpleasant surprise later on.