Save time and money with in-network care

By The Health News Team | April 11, 2023

Woman filling out form in doctors office

If you have a health maintenance organization (HMO) plan, you’ve likely been told to get care within your network. It’s good advice — staying in-network can help you to save time and money, whether you’re scheduling a yearly doctor’s visit or need to visit an urgent care center.

“An HMO is a type of health insurance that contracts with a network of physicians or medical groups and offers care at set, and often reduced, costs,” explains Don Truong, director of sales at Sharp Health Plan. “HMO plans require members to get care within their network of providers, hospitals and facilities. Otherwise, services aren't covered.”

While exceptions are made for emergencies, for the best experience, and to make the most of your health plan’s HMO benefits, you’ll want to find providers and facilities in your network. If you’re unsure which providers or facilities are in your network, it’s a good idea to check with your health plan before getting care. This will help you avoid any unnecessary costs for accessing care out of your network.

“One of the great things about Sharp Health Plan’s HMO product offerings is that we offer direct access to a wide range of award-winning providers and facilities as part of Sharp HealthCare’s integrated delivery system,” says Truong. “We even offer HMO plans as low as $0 a month for eligible individuals and families through Covered California™.”

Regardless of who you’re insured through, here’s Troung’s top tips for getting care in your network.

1

Know the differences between in-network and out-of-network care.

When you’re enrolled in an HMO plan, you have a network from which to choose your care. “Much like a preferred provider organization (PPO) plan, HMOs have a network of doctors and hospitals that you can choose from,” explains Truong.

All health plans offer a provider directory that allows members to search for providers, hospital and facilities to make sure they’re in their network before getting care.

“If you visit a provider who isn’t in your network, you will likely be responsible for paying the entire cost, except in the case of an emergency,” adds Truong. “This can be costly because when your health plan doesn’t have a contract with a provider or facility, they can’t control what you’re charged for the services you receive.”

2

Choose in-network providers and facilities when you need urgent care too.

If you need same-day care outside of your doctor’s office hours, or if your doctor isn’t available, an urgent care center is a good option.

Knowing when to go to an urgent care center or emergency room is important — and these tips from Sharp HealthCare can help. “It’s important to find one within your network and your plan medical group,” recommends Truong.

Before you get care, have this information ready:

Know your network. This information should be available in your member handbook. Some health plans may also make this information handy on their member ID cards or through their member accounts online. When in doubt, call your health plan to make sure you know what your network is.

Know your plan medical group. Examples of plan medical groups include Sharp-Rees Stealy Medical Group, Sharp Community Medical Group and SharpCare Medical Group, among others. This information should also be available in your health plan’s member handbook and may also be listed on your member ID card or online through your member account.

With this in mind, you can search for nearby urgent care centers in your network and plan medical group. Select locations will let you save a spot in line, and select medical groups offer convenient virtual urgent care visits too.

Learn more about Sharp Health Plan; get the latest health and wellness news, trends and patient stories from Sharp Health News; and subscribe to our weekly newsletter by clicking the "Sign up" link below.

The Health News Team

Author

The Sharp Health News Team are content authors who write and produce stories about Sharp HealthCare and its hospitals, clinics, medical groups and health plan.