Is Your Doctor Covered by Your Insurance Plan?
Insurance companies often offer coverage based on healthcare networks—a group of medical facilities that essentially agree to accept payment from the insurance company. These are generally broken into groupings of public and low-cost facilities, mid- to high-cost facilities, and unlimited networks.
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Did you recently get new health insurance? Are you wondering which doctors are included in your insurance network? Are you concerned insurance won’t cover your doctor visits?
This article will outline the three most common groups of health insurance networks by facility type, help determine whether your doctor is covered by your insurance, and more. Let’s get started.
How To Find Out if Your Insurance Covers Your Doctor
You can find out if your insurance covers your chosen medical facility or doctor by looking at documentation in your plan, by contacting your doctor’s office, or by utilizing professional help from a broker. Let’s dive into each of these options more.
1. Look at the Documentation Included with the Plan
All plans come with documents that explain not only what is covered but also where you can receive medical attention. For example, if you buy a plan through Pacific Prime, we send you a Quick User Guide with information on your plan, including where you are covered.
Other plans, especially local ones, will also come with a booklet or a link to a website that lists all locations, clinics, and hospitals where your plan is accepted. When you sign up for a new plan, it is a good idea to store this information securely so you have access to it when you need it.
2. Contact Your Main Doctor and Ask
If you have had your plan for a longer period of time or are unsure whether your doctor or clinic of choice will accept your insurance plan, simply contact the office directly. They will likely be able to tell you right away if they are part of your provider’s network.
3. Talk to Pacific Prime’s Brokers
Living abroad, English may or may not be spoken to a level where you can communicate effectively with the receptionist at the clinic or hospital you have selected, so calling and asking may leave you with more questions than you started with in regards to coverage.
Contact one of our knowledgeable health insurance professionals to answer your questions. Because we work closely with virtually every health insurance provider, we can provide you with the details you need and even recommend a solution if one is necessary.
The Three Types of Insurance Networks
Most insurance providers select who will fall under their coverage by utilizing tiered coverage. Most networks either cover public and low-cost facilities, mid- to high-cost facilities, or unlimited networks.
Group 1: Public and Low-Cost Facilities
Network plans that support public and low-cost facilities are designed to be very cost-effective with lower premiums and, subsequently, lower limits and benefits.
If you purchase one of these plans, you will only have access to lower-cost facilities because the limits will only cover the costs at these facilities. This is especially important to note if you are relocating to a different country.
While some insurers do not cover treatment outside of your network, others will. This depends on the insurer you choose. In fact, many will give you the flexibility to still visit doctors and hospitals outside of the network, but they will only provide coverage up to the average cost of facilities.
So if you do purchase a budget plan and they tell you that your doctor or hospital is covered, you still need to be careful and check the coverage limits. The plan won’t be very useful if it only covers a small amount of what your desired doctor actually charges.
Listed below are the characteristics of plans in this category:
- Cost-Effective Coverage: Designed for low-cost providers and public facilities, these plans offer lower premiums by limiting benefits.
- Limited Benefit Limits: Coverage is capped at the average costs of public facilities, meaning high-cost services may not be fully covered.
- Ideal for Relocation: These plans are especially useful for expats, as they provide affordable access to local public healthcare when relocating.
- Out-of-Network Flexibility: Some plans allow you to visit out-of-network providers, but reimbursement is limited to average facility costs.
- Coverage Verification: Always check the specific coverage limits to ensure your preferred doctor’s or hospital’s fees are adequately covered.
Group 2: Mid- to High-Cost Facilities
Mid- to high-cost facility networks offer higher limits and a larger healthcare network but may still impose coverage limits, copays, or deductibles on treatment costs. These plans are designed to allow greater flexibility in selecting your hospital.
A copay is a part of the treatment cost that you pay out of pocket. This amount is set before the start of the policy and helps to manage the cost of your plan and to manage risk. Copays allow you to receive care without paying a high annual insurance premium.
The main downside to mid- and high-cost facility networks is that they may still limit access to the most expensive facilities in your area, especially those that are extremely specialized or serve only a small niche market.
Listed below are the characteristics of plans in this category:
- Expanded Network & Higher Limits: These plans offer a broader range of providers and higher coverage limits, giving you more flexibility in choosing hospitals.
- Cost Sharing: Expect copays, deductibles, or other limits; you pay a portion of the treatment cost as pre-agreed upon in your policy.
- Risk Management: Shared costs help manage premiums, ensuring you receive quality care without an exorbitant annual fee.
- Limited Access to Premium Facilities: Although you gain more options, access to the most expensive or highly specialized facilities may still be restricted by lower coverage limits.
Group 3: Unlimited Network
Plans with unlimited networks are typically offered by international insurers and will have high or no limits. Yes, the premiums for these plans are typically more expensive, but they enable access to the very best care that the world has to offer.
Because of their international nature, these plans are also most suitable for expats and individuals because they provide coverage in facilities and locations that will feel most comfortable to them—e.g., an expat’s home country.
Another benefit for expats is that these types of plans allow for treatment immediately, without waiting months to re-enroll in the public healthcare system if they move to a new city or country.
Listed below are the characteristics of plans in this category:
- Extensive Global Coverage: Unlimited networks offer access to top-tier healthcare facilities around the world, often with high or no coverage limits.
- Premium Quality Care: These plans have higher premiums but ensure you receive the best medical care available internationally.
- Ideal for Expats: Designed for expats and globally mobile individuals, they provide coverage in familiar or home-country facilities.
- Immediate Access: Enjoy prompt treatment without waiting periods associated with re-enrollment in local public healthcare systems.
Why You Should Consider Contacting a Broker
Working with an expat health insurance broker is essential in today’s international healthcare landscape, as they ensure that your coverage meets your unique cross-border needs while simplifying complex policy details.
Here’s why partnering with an expat health insurance broker is advantageous:
- Tailored Global Coverage: Brokers assess your unique lifestyle and recommend plans that provide comprehensive coverage across multiple countries and medical networks.
- Expert International Guidance: They offer in-depth market expertise and explain policy nuances, ensuring your health plan is competitive and compliant with local and international regulations.
- Streamlined Cross-Border Administration: Brokers simplify the enrollment, claims, and renewal processes, reducing the administrative burden of managing health insurance abroad.
- Cost Optimization for Expats: Leveraging global market insights and trends, brokers help contain costs and prevent premium escalations while preserving robust, high-quality coverage.
Frequently Asked Questions
How can I find out if my doctor or medical facility is covered by my insurance plan?
Start by reviewing the documentation provided with your policy, which typically includes a list of covered providers. If you’re still unsure, contact your doctor’s office directly to ask if they are in-network, or consult with a knowledgeable broker.
What are the different types of healthcare networks offered in these insurance plans?
Insurance plans generally fall into three network groups: plans with public and low-cost facilities offer basic, cost-effective coverage; mid- to high-cost facility plans provide higher limits with shared costs through copays or deductibles.
What should I do if my preferred doctor isn’t in the network?
If your preferred doctor or facility isn’t listed, check if your plan allows for out-of-network coverage (often with limits based on average costs). Alternatively, discussing your options with a benefits broker can help you identify a plan that aligns with your needs.
Conclusion
Understanding your health insurance network is key. If your doctor or facility isn’t covered, you risk unexpected costs. Review your plan’s documentation and verify network details to avoid surprises.
Network options vary from basic public facilities to unlimited international coverage. If you’re unsure, be sure to contact your provider or check your plan’s guide for clarity on covered services, especially before relocating.
For expert advice on expat health insurance and network coverage, contact Pacific Prime today. With over two decades of experience, our brokers can help you find the right plan for your needs and budget.
Upon graduating from Mahidol University International College’s International Relations program, he spent his career in marketing and business development, working for an international subcontractor, a marketing research firm, an international news agency, a software development company, and a creative agency. His journey now continues at Pacific Prime, where he hopes to make an impact by simplifying insurance and writing a gargantuan amount of SEO articles to draw in billions of leads.
In his free time, Piyanat is an avid martial artist and musician, spending most of his time at boxing gyms in Nakhon Pathom and music studios with his friends in the music industry.
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