Thursday, February 27, 2014

What if I need to see a provider that's not in my health plan's network?

Many of  the health plans for sale in Washington's new Exchange - Wahealthplanfinder - have narrower provider networks. This trend helps keeps premiums down, but it can be confusing and upsetting to consumers who are used to seeing certain providers.

If you don't qualify for a subsidy and you want a broader selection of providers, you may want to consider buying a health plan outside of the Exchange. You can do so by contacting a health insurer directly or an insurance agent can help you. Here's a list of all plans available inside and outside the Exchange by county. Make sure you check the plan's provider directory before you sign up.

Consider these tips on network issues to consider before signing up for coverage.

If you need medical care that cannot be provided by a provider or facility in your plan's network, your health plan must allow you to see the out-of-network provider network at no greater cost than if they were a contracted provider. Read more about your rights to see certain providers.

If you believe you're being treated unfairly by your insurance company, file a complaint with us - we'll look into if for you and make sure your health plan is following the rules.

Want to get more involved? We're currently working on new rules about provider networks. One of the goals is to increase transparency - so you know which providers are covered by your plan and how to access care you need, if they're not. Join our listsev to get updates on this new rule.