Accredited network: what is the relevance in choosing the health plan?

Accredited network: what is the relevance in choosing the health plan?

By choosing a health plan, you need to pay close attention to the accredited network offered, ie the provider of health services network that you have at your disposal. It is important to be inside the frame available from doctors, hospitals, laboratories for exams and emergency care.

To help you in this task, we have prepared a guide to everything you should remember before closing the deal with your new health provider! Let’s check?

What is accredited network?

The provider network (referenced or contracted) is formed by doctors of various specialties, health care providers, hospitals, clinics and laboratories that are contracted by the operator’s insurance or health plan and that will suit you and your family.

Generally, you can consult the accredited by the site health plan or a phone number. Before hiring, a good tip is to ask where and how you can access the information of the accredited network. Often, a plan that has a regional provider network, near his home, may be the best option.

What is the importance of accredited network in choosing the health plan?

If you are in doubt about which plan to choose, analyze well the provider network. Check for hospitals and doctors near your home or work. If you need an appointment with a doctor or hospital outside the accredited network, learn how to query refund works.

Once hired the health plan, the ideal is preferably use doctors and hospitals in the referral network to avoid the dreaded and unexpected additional costs.

What is the scope of the accredited networks?

Health plans may have regional coverage, state, national, or even international, in cases of travel. As the scope, the price of the plan may be higher. So it is important to consider what your needs

Often more interested in having a good doctor in your neighborhood, than a huge national network, or international, if you do not usually travel a lot. With regard to scope, it is better to rely on the quality and reputation of establishments and professionals you have at your disposal than the amount of the provider network.

How do I know if the plan contracted network I intend to hire is good or not?

According to the National Health Agency (ANS) , the operators of health plans must offer the consumer a promotional material with the qualification of each of its accredited. If the operator of the health plan you plan to hire did not provide this information, be suspicious.

In the ANS site you can consult the operator of the position you want to hire in the ranking called “the Operators Performance Index”. You can make your query with only the carrier name, or with the record number in her ANS or CNPJ number.

The size of the accredited network offered influences the price of health insurance?

In general, the plans offer an extensive network also accredited are the most expensive. Many health plans offer dental coverage, obstetrical, hospital, outpatient, and laboratories for medical tests. Find out! Do not go pay more for a service that you will never use.

If you do not intend to have children, for example, obstetrics and maternity service is completely unnecessary. And vice versa, that is, ensure that the plan will not let you down without offering a good orthopedist, if in case you like to play sports and play football with friends at the weekend.

And if the health provider solve change the partner network, excluding any physician who is helping me?

The NSA requires the healthcare provider keep the accredited offered to the consumer in the hiring of his plan. If you need to change something, the operator must apply for authorization to the NSA and can not do anything before obtaining such approval.

In this case, the operator must follow what the law states:

  • to exclude from its provider network a provider of health services, the operator needs to evaluate the entity’s service capacity you want to delete, and need to maintain coverage in the same quality standard at no additional cost to the consumer;
  • to replace the partner network a provider of health services, the operator needs to provide another to keep the same standard of quality and services. In this case, the law requires to inform the consumer and ANS with a month in advance.

Is there any punishment to the doctor, laboratory or hospital provider network who refuses to meet me or meet someone in my family?

Yes. The contractor can and should be attended by all the accredited offered by health plan provider. The operator should be responsible for this service, without any impediment or refusal. But if there is no justification to refuse service, the service provider may be punished for breaking the law.

What if I do not like the attendance of some accredited professional network, how do?

The ANS has assessed the health insurance companies, and maintain the quality of the provider network has been a concern of all of them. But if there is some kind of problem, know who to turn to:

  • First, you should turn to their health care provider, which should provide communication channels easily accessible to the consumer so that it can easily register your complaint and have a satisfactory answer as soon as possible;
  • a second option would be to contact the ANS, ANS by DIAL phone 0800 7019656, or by site .

Therefore, the provider network is one of the most important items at the time of hiring a health plan. Review the items highlighted in this post and make the best choice for your needs, choosing always a plan that fits in your pocket.

Now that you know the importance of accredited network, such that understand how to evaluate a health plan? Now meet the main criteria used in the evaluation  of this service!


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