Will My HealthShare Use a Provider Network?

As you compare HealthShares with traditional insurance plans, you may wonder if HealthShares also use provider networks. The short answer is: sometimes! After reviewing current HealthShares, we found that the following do not use a provider network: Samaritan, Solidarity, Liberty, Sedera, and Christian Healthcare Ministries. Other HealthShares may ask members to visit providers in their preferred provider network, though most do not make it a requirement.

What is a provider network?

A network is a group of healthcare providers, like doctors and hospitals, who have all agreed to accept certain payment amounts for their services. They are contracted with insurance companies at specific rates. Insurance companies use networks because it helps them negotiate medical bills and save money. Some HealthShares also use networks for similar reasons.

HealthShare networks vs. insurance networks

HealthShares that use a network, similar to some traditional insurances, offer better sharing benefits for staying in-network. The main difference between these HealthShares and traditional insurance is that some insurance plans will cover nothing at all if a member goes out-of-network. HealthShares usually still share, but at a reduced rate.

Networks can benefit HealthShare members by offering discounted service rates and making billing easier. However, if your HealthShare requires a network, it means the providers you are allowed to visit will be restricted to this network.

There is one exception. In-network or out, all HealthShares ask members to visit accredited providers and facilities. You can’t go to Uncle Joe’s back shed for surgery, even if he used to be the greatest surgeon on the planet. No HealthShare will share the cost for seeing an unlicensed provider, so don’t do it.

A popular provider network

Many HealthShares with a preferred provider network use the same one, so I want to introduce you to it. The network is PHCS/Multiplan.

The good news is that PHCS/Multiplan is enormous. Health insurance companies frequently use it as their provider network, and it has providers all over the country. The bad news is that PHCS and Multiplan used to be separate networks. Multiplan acquired PHCS, so you might need to double-check some things with your HealthShare. Multiplan’s website doesn’t explain whether a PHCS provider also belongs to the Multiplan network, so it’s best to ask your HealthShare directly if you’re confused. Fortunately, most HealthShares include a Provider Search on their website. Using the company’s web search is the best way to ensure that your doctor will be in-network.

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