Check Provider Networks Before You Get Care

Check Provider Networks Before You Get Care

Check Provider Networks Before You Get Care
What is a Provider Network?

You may have heard that premiums, copays and deductibles are all things you need to think about in your search for the best health plan for you or your family. But did you know that you should also be thinking about the plan’s provider network? Here's why.

  1. Health plans save you money by getting discounts on health care charges from doctors, hospitals and other health care providers. When a provider agrees to take patients with a health plan, that means they agree to take the lower amount for their care.
  2. Some plans’ provider networks have less doctors and hospitals than others. The plan is lower cost to the member because they pay less to providers who see those members.  That means fewer providers will agree to be in that plan’s network. It also means that the smaller networks have less choices of doctors you can use when  you need care
  3. You can keep your out-of-pocket costs low by using the doctors and other health care providers in your plan’s network. If you visit a doctor outside of your network, you might have to pay more for your care. In some cases (such as HMO plans), you may have to pay the full cost when you go out of network. If your family has certain doctors, specialists, hospitals and urgent care centers you use, make sure they are in the network of any health plan you consider.
Compare Insurance Plans In-network or out-of-network Provider Network TX
Provider Networks: HMO vs PPO

While there are other options of health plans, the two most common are HMOs and PPOs.  An HMO may have lower monthly premiums, but you'll have a primary care physician (PCP) to direct your care within the network. You''ll need a referral from your PCP to see a specialist. In a PPO plan, you may pay a higher premium but have more freedom to choose doctors and hospitals and do not need referrals.

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

  • Is it important to me to have a lot of doctors and hospitals to choose from?
  • Is it worth paying a higher monthly premium to  have more provider choices?
  • Are the providers I often go to in my chosen plan’s network?

Insider's Tip: Use the BCBSTX Provider Finder® online to see what doctors, hospitals and urgent care centers are in network for the plan you are looking  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.

Originally published 12/10/2014; Revised 2020, 2022