A network is a group of healthcare providers, including doctors, hospitals and other medical facilities that have agreed to provide services at discounted rates to members of a specific health plan. Networks are designed to manage costs and ensure quality care.
Knowing your network is smart and helps you get the most from your plan.
See how it maximizes your MyPriority plan benefits.
Types of networks
- Health maintenance organization (HMO): an HMO plan requires you to use in-network providers and get referrals from a primary care physician (PCP) to see specialists.
- Preferred Provider Organization (PPO): a PPO plan offers more flexibility, allowing you to see both in-network and out-of-network providers, though at a higher cost for out-of-network care.
- Narrow network: Narrow Network plans offer lower premiums and provide access to quality care within a specific network of doctors and affiliated providers.
What is a provider?
A provider is an individual doctor, clinic, hospital or other health care entity that offers medical services. Providers can be either in-network or out-of-network:
- In-network providers: these providers have contracts with your insurance plan to offer services at reduced rates. Using in-network providers usually means lower out-of-pocket costs for you.
- Out-of-network providers: these providers do not have contracts with your insurance plan. Using out-of-network providers typically results in higher costs, and some services may not be covered at all.
How do I check if my current provider is in network?
It's important to check if your preferred doctors and hospitals are in-network to avoid higher out-of-pocket costs. If you have a MyPriority® plan, there are a few ways to check if your doctor is in network:
- Call your provider directly
- Speak with a Priority Health enrollment specialist
- Use Priority Health's Find a Doctor tool to check a specific network
What happens if I see an out-of-network provider?
Depending on your plan, seeing an out-of-network provider can result in higher costs or no coverage at all. It's essential to understand your plan's rules regarding out-of-network care.
Are there any restrictions on accessing specialists?
Some plans require a referral from your primary care physician to see a specialist. However, MyPriority plans do not require a referral for in-network specialists. Check with your primary care provider to see if a referral is needed.