In comparing HealthShares and traditional insurance plans, questions may arise as to whether HealthShares use provider networks, as is typical within the health insurance industry. Research indicates that certain HealthShares, including Samaritan, Solidarity, Liberty, Sedera, and Christian Healthcare Ministries, do not work with a provider network. Other HealthShares may ask members to visit providers within their preferred provider network, though it is generally not mandatory.
What is a provider network?
A provider 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 companies at specific rates. Insurance companies use such networks because it helps them negotiate medical bills and save money, a strategy also used by some HealthShares.
HealthShare networks vs. insurance networks
HealthShares that use a network 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 a HealthShare requires a network, it means members will be restricted to providers and facilities in the network if they want their expenses to be eligible for sharing.
Regardless of whether a service is in network or out of network, all HealthShares require that members consult accredited providers and facilities. HealthShares will not share in the expense of consultations or treatments by unlicensed providers.
A popular provider network
The PHCS/Multiplan network is used by many HealthShares with a preferred provider network. This network is large and commonly used by health insurance companies, with providers available nationwide. Unfortunately, since Multiplan’s acquisition of PHCS, a level of ambiguity exists around whether a PHCS provider is also part of the Multiplan network. In considering an organization using this network, it is best to ask the HealthShare to clear up any confusion.
Provider network pros and cons
The use of provider networks within HealthShares presents both opportunities and challenges. These networks can offer cost-saving benefits and streamline the billing process for HealthShare members, but they also restrict which providers members can visit. As the HealthShare landscape continues to evolve, understanding these dynamics can help members understand their healthcare options better.
