MEDICAL SUPPLIER NETWORKS
IN THE HEALTH MARKET
What should I do to find out if my doctor belongs to the plan's network before enrolling in health coverage through the Marketplace? The first thing you should do is a list of the providers you use. Remember that doctors, pediatricians, psychologists, physical therapists, specialists in general, medical dependencies such as hospitals, urgent care clinics and pharmacies are considered providers.
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Check with our specialists for the provider directory to find out which health professionals or entities are in the network and which are outside the plan's network. Insurance companies may have different networks for different plans. It is important that before choosing your coverage and your family review the list corresponding to the specific plan that interests you.
Exclusive provider organizations - It is a managed care plan where services are covered only if you see doctors, specialists or hospitals within the plan's network, except in an emergency.
Organization for the Maintenance of Health (HMO): A type of plan that usually limits coverage to the care provided by doctors who work for or have contracts with HMOs. In general, they do not cover out-of-network care except in cases of emergency.
Organization of Preferred Providers (PPO): A type of plan in which you pay less if you use the services of providers that belong to the plan's network. You can use the services of doctors, hospitals, and non-network providers without a referral if you pay an additional cost.
Point of service plan (POS): A type of plan in which you pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network.
All plans sold in the Insurance Marketplace must have a network with a sufficient number of providers so that their members can access the covered services without undue delay. Remember that if you use a service provider that is out of the network, you may have to pay the full price of the benefits and services you receive from that provider, except in cases of emergency.
If you get emergency services from a provider who is not in the plan's network, those services will be covered by the Marketplace insurance plan, just as if you had a network provider. However, providers may bill you for other costs related to the emergency services you have received according to healthcare.gov.
If you enrolled in an insurance Marketplace plan and then realized that your doctor does not belong to the plan's network, you can through our agents switch to another Marketplace during open enrollment that starts on November 1 or a plan that is not offered through the Marketplace.
Contact us at the Call Center at 786-650-1514 if you need help requesting coverage and enrolling in a Marketplace plan.