How Does a Health Plan's Network Impact Health Care Costs for You and Your Clients?
Doctors and other providers who participate with a health plan are considered in-network, and members typically pay less for their services than they would for the same health care services from out-of-network providers.
To help your clients better understand the impact of a “network” on their potential for unexpected out-of-pocket healthcare costs, Excellus BlueCross BlueShield developed an infographic on costs for in-network provider services vs. out-of-network.
Some of the examples used to help illustrate the potential for extra costs include:
- Falling and breaking a leg: your clients and their employees might pay $4,000 more out of their pocket if they see doctors who are not part of their health insurer’s provider network, compared to seeing doctors who are in-network.
- Concussion: your clients and their employees could pay $500 more out of their pocket.
- Cesarean section: your clients and their employees could pay $3,000 more out of their pocket.
- Knee replacement: your clients and their employees could pay $11,000 more out of their pocket.
How can you help your clients and their employees avoid unexpected out-of-pocket healthcare costs?
Before choosing a health plan, encourage your clients and their employees to determine if their doctors are in the health plan’s network, and to consider the following pros and cons of choosing plans with large or small networks:
- A plan with a smaller network has fewer doctors and smaller premiums -- but they risk big medical bills if they visit out-of-network providers.
- A plan with a large network offers more doctors and larger premiums – but might protect them from unexpected bills. If they need a new doctor in 2015, for example, having a plan with a large network will increase the chances that the provider works with the plan.
Current Excellus BCBS members can determine if a doctor is participating in our network by:
- Calling the Customer Service telephone number on the back of the member ID card.
- Visiting ExcellusBCBS.com where provider networks are posted with search tools to easily navigate the list.
For more information, view the Out of Your Pocket infographic or contact your account consultant.