Hixme Think

Is “My Doctor” In-Network?

Denny WeinbergDenny Weinberg

Last week’s post, Is My Hospital In-Network? relieved some anxiety and misunderstandings about local hospital network status with health insurers. Now, you can take some comfort knowing:

  1. In a true emergency, health care rights and services rules, not insurance companies (IN or OUT-of-network) will assure that you are most quickly and most appropriately cared for.
  2. You will further benefit from Continuity-of-Care-Protections, wherever you undergo medical care
  3. For hospital-based medical services that can and should be pre-planned, your treating physician will have the important considerations for you about where and when that care should occur.

So now, perhaps your anxiety has moved to “Is My Doctor is In-Network?”

Context: There are around  One million physicians in the US,  or about 1 for every 325 man, woman and child.  Seems like plenty to meet the personal needs of working Americans.  

Looking Closer:  Fully half of them do not provide primary medical care at all (they are specialists of one kind or another). Further, physician concentrations and availability vary widely by geography and population dynamics. Finally, its nearly impossible to determine IN ADVANCE the complicated physician affiliations between and among hospitals, insurance plans and each other. These changing and complex affiliations often make access to care challenging. Emergency Room, Anesthesiology, Lab & Pathology services are especially unpredictable.

But these concerns are not critical for everyone:

And, its great if you are older or poorer:

But, if you not old and not poor:  Things don’t look as great for the rest of us, and there are important trends and dynamics related to In-Network and Out-of-Network status, especially for today’s PPO systems.

Then, is this In-Network issue for “My Doctor” an emotional or even philosophical question rather than economic or practical?  It’s an interesting question in today’s marketplace.  Consider:

So why are we so focused on paying a ton more in premiums every single month for the right to “have access to my doctor”, which  we likely can’t control much these days any way ? 

Perhaps we have been “behavior modified” over the years to expect the answer to “is my doctor In-Network” to be “Yes”…. even if “no” or “maybe not” is far less expensive and perhaps even more workable for those relationships

Denny Weinberg is a 35 year veteran executive in healthcare financing and operations. Prior to his 4 years as investor and CEO with Hixme, his broad background includes a 20 year tenure CEO of a number of Anthem's largest operating companies. Denny has managed a portfolio of early stage companies in the Health/Medical arena as well as other industries. He has also served as board member, advisor and consultant to both private equity-backed, and publicly traded Blue Chip companies.

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