Coventry Health Insurance of Georgia (GA) | Family Health Insurance Georgia | Using Your Family Health Insurance Georgia Provider Network

Family Health Insurance Georgia

Using Your Family Health Insurance Georgia Provider Network

There are many advantages to going in-network when you are using your family health insurance Georgia policy. First, let's define in-network. If you have a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) family health insurance Georgia policy, there will be certain doctors that are considered in-network, and everyone else is considered out-of-network. Network physicians have agreed to a lower, negotiated rate as part of their network contract status. Hospitals and pharmacies are also either in-network or out-of-network for particular types of family health insurance Georgia plans. Typically, the only plans that do not use physician networks are Point of Service (POS) plans. With these POS plans, you can see any physician you choose at the same rate.

However, if your family health insurance Georgia policy does pay different benefits whether you see an in-network or out-of-network physician, then you are better off visiting physicians who are part of your family health insurance Georgia network. The reason for this is that their charges will be lower. If you have to pay a certain percentage of the costs are your co-insurance responsibility, then you will benefit from the lower in-network rate. For example, a physician may charge $100 for an office visit. As part of their contract with your family health insurance Georgia company, they have agreed to a contracted rate of $80. If you are responsible for 20% co-insurance, then you are saving $4 ($20=20% of $100, and $16=20% of $80). These kinds of savings add up throughout the year, and really make your family health insurance Georgia more beneficial.

Another big advantage of seeing a family health insurance Georgia network provider is that typically, they are required to only accept your co-insurance portion, and then they are responsible to bill the family health insurance Georgia company directly for their portion. If you go out-of-network, it is possible that the physician will ask you for 100% of their full fee, and then you will be responsible to file claims with your family health insurance Georgia carrier in order to be reimbursed. This is often a complicated process for most people who are not familiar with claim forms and HCFA-1500s, etc. It is often the most convenient to see a physician who is a part of your family health insurance Georgia network, pay only your co-payment, and then let them submit claims and see their own reimbursement. You will still be kept informed of the claims submission process by receiving an Explanation of Benefits (EOB) from the family health insurance Georgia company.

A third advantage of seeing an in-network physician is that they are often familiar with other physicians and specialists in your region and who are also part of your family health insurance Georgia network. If you ever need additional medical services, or a specialist for a second opinion or other types of medical treatment, your physician will be able to refer you out to a trusted colleague. This will help you feel more comfortable with the referral process. Again, you will want to make sure that this other physician is also a part of your family health insurance Georgia network so that you can continue to enjoy the convenience of in-network benefits.


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