Definition
The term network providers is usually associated with managed care plans such as health maintenance organizations (HMO), preferred provider organizations (PPO), and point of service (POS) health insurance plans. Companies offering managed care programs recruit physicians, hospitals, and laboratories to participate in their network.
Explanation
Assembling a network of medical providers allows the insurance company to establish standard fees for services. This also means each insurance company will have a different list of network providers, and the company's network may even change slightly with each managed care plan. When presented with a choice of medical plans, the participant will usually search each company's list of care providers to see if their existing physicians are participating in the network.
If a plan participant seeks medical care with an out-of-network provider without gaining approval from their primary care physician and insurance company, both deductibles and coinsurance payments may apply; resulting in significantly higher out-of-pocket costs.
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