Everyone has heard of provider networks, and while they’re less common for health shares than traditional health insurance, they’re still a factor you need to consider. A provider network is made up of doctors and other health care providers with a contract to provide medical care to its members, often at a discount.
Many health shares do not use provider networks, but some still do, and it’s important to understand the different approaches, and how a provider network may affect your membership. While provider networks offer certain benefits, they also come with certain restrictions, which we will discuss below.
Health shares that don’t use a provider network
Health shares that don’t use a provider network, like Christian Health Ministries or Zion HealthShare, emphasize the freedom it gives to choose your own provider, such as your primary care doctor, without worrying if they’re out-of-network. Also, if you travel, or live in a remote area, you may have a harder time finding in-network providers, so having the flexibility to choose providers closest to you may be a game-changer.
While provider networks can be great for getting their members discounts on medical expenses, and have enough providers to ensure their members can get services without unreasonable delay, they can also cause some frustrations.
Since health shares often share medical expenses out-of-state, and may even share some incurred out-of-country, it may be frustrating to have to check if providers are in-network wherever it is you may be traveling. Additionally, members in rural areas may struggle to find providers nearby that are in their network, which could lead to longer commutes when seeking healthcare.
Most health shares have abandoned the use of provider networks, or never used them in the first place. But some health shares still use a provider network, so it’s important to know what that means if you’re one of their members.
Health shares and PPO networks
Medi-Share, for example, uses a Preferred Provider Organization (PPO), a form of provider network, called PHCS/Multiplan. Since it’s a PPO, you will pay less if you see providers who are in your network. With a PPO, you can still see out-of-network providers, although if you do you will incur additional costs (see Section V. of the Medi-Share Guidelines). With our example company, Medi-Share, members have “an additional responsibility of 20% of total charges” above their IUA if they see out-of-network providers, which is definitely something to consider if, for instance, your primary care doctor is not in your health share’s network.
Health shares and EPO networks
Currently, it’s unlikely (none of the companies on this site use an EPO) you will encounter a health share uses an Exclusive Provider Organization (EPO), which will only pay for medical expenses incurred at in-network providers. But it’s still important to research the relevant sections of your health share’s guidelines to see if provider networks are something you need to prepare for.
The open-network approach, which allows members to choose their own providers, is a popular one among many health share members. Whether you’re looking for the benefits that come with a health share using a provider network, or would prefer the flexibility that comes with the open-network approach, there is a health share for you. If you’re curious about whether your health share uses a provider network, we encourage you to call them and ask any questions you may have.