4 Tips for Choosing the Best Accredited Network in Your Health Plan

4 Tips for Choosing the Best Accredited Network in Your Health Plan

When hiring a health plan, one of the factors that should be considered is the accredited network . It is formed by doctors of various specialties, hospitals, clinics, laboratories and other health care providers.

Also known as referenced or contracted network, it is what determines the care and services that you can use the plan, so it is important to know it before closing the contract.

There are several factors that must be considered to ensure that the contracted service will meet their needs, in order that networks can meet in different locations and offer several options for service providers.

Being a choice as important, we have prepared this post with 4 tips for you to follow in deciding the accredited in your health plan. Check out!

1. Assess the facilities of the service outlets

When considering hiring a particular health plan , you must request information on the accredited networks and different services offered. This provision offers a number of areas covered and, consequently, professional and accredited services varied.

By analyzing the options, check the frame available from physicians, laboratories, hospitals and emergency care. With this information in hand, you need to examine the map of the accredited network of your plan, or check where is located each service provider.

A large provider network is often advantageous for the different options and the scope of service, however, often the quality of care in a particular region can have a smaller network bring more benefits.

Therefore, it is important to check the next options from their place of work and / or residence, especially in some cities such as São Paulo. Thus, you avoid having to make large displacement when you need care, especially in emergencies.

In addition, well analyzing the service map, you can ensure more convenience with calls coming to places you already go to, without having to cross the city and face hours of traffic to get to the site.

2. Know and enjoy all the benefits the plan offers

When hiring this service, it is common for people to believe that the plans with greater scope and differential are the best. However, this does not always happen.

It is important to know that each service offered by the plan directly influences the amount of tuition. Therefore, when choosing a broader network without assessing whether it is really necessary, you will probably have higher costs without taking advantage of the benefits.

Considering the service locations, sometimes the provider network offers several options in different locations, but you will only make use of part of these consultations.

Using the city of São Paulo again as an example, to hire a health plan that provides care in the Albert Einstein Hospital, when, in fact, only uses calls the Hospital São Luiz, you will be having a higher cost for a service that does not Is it used.

With the help of a broker as Buddy Health, you can identify your profile to find the most personalized plan that is tailored to your needs, with an accredited regional coverage network, state, national or even international, and fits your budget.

3. Check the repayment options

The reimbursement in the health plan is carried out in some specific situations. By law, the consumer is entitled to receive reimbursement of amounts spent on emergency visits or emergency, when there is no professional or the local accredited service providers that was conducted the service.

Remember that elective medical appointments are not reimbursed. However, there are also plans that offer free choice mode, or you can request the refund of any query.

Thus, if the provider network does not offer some specific calls you want to rely on a free choice of plan may be an appropriate solution, allowing you to perform queries and use the medical services of their choice.

It is necessary to pay attention also to the reimbursement amount, which is determined by the operator, which can be a percentage or a fixed amount, which does not always cover the beneficiary spending.

Therefore, during the negotiation, it is essential to request the current table to check the prevailing values, application procedures and deadlines which the beneficiary must comply to qualify for reimbursement.

4. Analyze the relationship between the price and benefits of network

After following the other tips, it’s time to make an analysis of the cost-benefit of each provider network. Analyze your real needs, the types of examinations and medical care you would like to have.

With all the data in hand, it’s time to analyze the options offered, making a comparison between the benefits of each provider network. A few points that may help at this time are:

  • which serves more specialties?
  • is there any particular service is not covered by all networks?
  • which network will offer more convenience?
  • which are periods of shortage of each plane?

The needs specifically are essential to analyze the plan with the best network. During this period, the beneficiary will only pay the tuition, but will not have access to certain covers. So it is important to consider whether any operator offers reduction options or allow the purchase deficiency , which can be the difference in defining the best network.

By answering these questions, you will be able to identify which plans and options referenced networks offer the services you really need.

Finally, we need to ensure the best cost-benefit in hiring. To do this, compare the offered values ​​and the different proposals, evaluating the differences in costs and services offered in each. So, you be able to view what is most appropriate considering your needs and your budget.

Choosing a health plan and a provider network is quite delicate, but by following these tips, you will be able to define the most satisfactory service to your profile, avoiding unnecessary costs or headaches from lack of care in desired locations.

Like our tips? Then contact us and learn about solutions that Buddy Health has to ensure the best care for you and your family! Come on!


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