Today’s topic is talking about the need for persons covered under Obamacare, specifically under the Affordable Care Act, to monitor and maintain your network.
The network under the ACA, or just categorically to any health plan, is a key component of our health insurance policies, whether it’s a benefit from my work or insurance I obtained on my own.
The First Question to Ask
The key question is: “What doctors or hospitals accept my insurance?” That is referencing what we call the network. The network is the list of doctors or hospitals that accept my insurance.
That is acutely important for a large margin of persons covered under the Affordable Care Act enrollments. If you’re covered under an Obamacare enrollment, you have got to watch your network.
The Second Question to Ask
Second point with reference to your network, if you would need to call a doctor or hospital and, say, “I’m covered by Anthem, or UnitedHealthcare,” or whatever name of the insurance company is.
So you call Dr. Jones’s office and say, “Do you accept______?” And you fill in the name of your insurance company. That is the wrong question. You need to know the name of your network.
In other words, all the insurance companies own a series of networks and they rent those or lease those to the insurance companies for their health plans. Every health plan has a unique network and they are referred to by a name.
An Example of One Network You Might Ask About
There’s a common plan here in St. Louis with Anthem and the name of their network for the Affordable Care Act is called Anthem Pathway. That’s just one example.
But Anthem owns three or four other networks, so if you would call your doctor and say, “Do you take Anthem?” They may say, yes, but that could be an inaccurate answer for you because you need to ask, “Do you take Anthem Pathway?”
Every Year, Networks Are Changing
Every year, these networks are changing, evolving and merging. This involves our doctor’s offices, medical practices and hospitals. Their participation in a network can change throughout the year.
Typically, it does not change on a broad basis until January 1st, but right now we are approaching another open enrollment season. For the next year, you should always check your network plus the pricing and deductibles and copays.
My staff and I are ready to help you figure out the best health plan for you, considering these changes every year. Call us at (314) 544-5400 and let us know how we can help.
