What You Should Know About Our Provider Network

What’s a provider network?

A provider network is a list of the doctors, other health care providers, and hospitals that FHCP has contracted with to provide medical care to our members. These providers are called “network providers” or “in-network providers.” A provider that hasn’t contracted to participate in a FHCP network is called an “out-of-network provider.”

How can I see if my doctor is in a FHCP network before I choose to join FHCP?

First, make a list of all the providers you use. Remember that “providers” include health care professionals like doctors, psychologists, etc. and health care facilities like hospitals, imaging centers, urgent care clinics, or pharmacies. When you compare plans, you can search for your doctor and medical facility by clicking on “Find A Doctor/Facility.” You can pick a plan in which you are interested, or search as a guest. As you compare plans, we’ll tell you if each plan includes these doctors and facilities in its network. If you want coverage for dependents, remember to search for their doctors and facilities too. FHCP has different networks for different plans, so make sure you’re searching the provider network of each specific plan you compare.

How do different types of plans use provider networks?

Depending on the type of plan you buy, your care may be covered only when you see a network provider. You may not be covered, or have to pay more, and/or get a referral if you choose to get care from a provider who isn’t in your plan’s network. Our HMO benefit plans limit coverage to care from providers who work for or contract with FHCP. An FHCP HMO benefit plan generally won’t cover out-of-network care except in an emergency or urgent situation. If you use a doctor or facility that isn’t in your plan’s HMO network, you may have to pay the full cost of the services you get. It is important that you have a primary care physician (PCP) and your PCP will refer you to see specialists.

Why do some plans cover benefits and services from network providers, but not out-of-network providers?

When a provider is a network provider for a plan, it means that the provider agreed to provide benefits or services to the plan’s members at prices that the provider and the plan agreed on. The provider generally provides a covered benefit at a lower cost to the plan and the plan’s members than if providing the same benefit to someone without insurance, or someone with insurance through a plan in which the provider is out-of-network. All FHCP provider networks include enough types of providers to ensure that our plan members can get plan services without unreasonable delay. If you use an out-of-network provider, you may have to pay the full cost of the benefits and services you get from that provider, except for emergency services. If you get emergency services from an out-of-network provider, those services are covered by FHCP as if you used an in-network provider.