Experient Health's Latest Guest Blog Tackles How To Pick a Primary Care Doctor

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Experient Health's benefits consultants are guest Bloggers with the Williamsburg, Va.-based Health Journal, helping inform the community about changes under the Affordable Care Act (ACA).

In the new world of health care reform, health insurance networks have become extremely important, and in some cases more complicated, Experient Health Benefits Consultant Jayson Richardson wrote in his latest guest Blogging spot with the Health Journal.

The Health Journal, a Williamsburg, Va.-based news magazine targeting health and lifestyle news for young and older adults in the Tidewater region of Virginia, partnered with Experient Health to publish routine Blog posts helping readers understand the changes businesses and individuals have seen under the Affordable Care Act (ACA).

This year, when most Americans were required to buy health insurance through the government marketplace, the rules changed for some who were used to doctors they had long used.

Some insurance carriers began only offering HMO plans, which have a smaller more limited network of providers, as opposed to PPO plans, which offer a more expansive selection.

"Bottom line: You may no longer be able to go to your regular doctor because of the changing insurance plans," Richardson wrote.

In the post, Richardson explained the different between HMOs, health-maintenance organizations, and PPOs, or preferred provider organizations.

"Consumers are now faced with the decision about whether to stay within their network—or to find new doctors because their old ones aren’t in that network," Richardson wrote. "In-network benefits generally have 80-20 percent coverage, while out-of-network means the consumer pays more, as much as 50 percent."

Consumers choosing individual health plans are having to make hard decisions — get a subsidized plan and pay less in premiums, but have less access to certain doctors and medical facilities? Or pay more in premiums and get a PPO policy? HMOs generally run 10 to 15 percent less in premiums than PPOs do.

"The decision can come down to how much a consumer wants to stick with a particular doctor, or medical facility. To help consumers figure out what plan covers what, the insurance carriers all have “find-a-doctor” searches on their websites that are changing constantly, with providers coming on and going off all the time," Richardson wrote.

"At Experient Health, we encourage individuals to use...search tools," Richardson wrote. "The choices are always changing, sometimes by the day. Whatever plan you choose, and whatever doctor you choose to see, it’s always wise to make a phone call ahead of time to be sure you’re covered. That part, at least, is still pretty simple."

To read the complete series, visit The Health Journal online.

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Stephanie Heinatz
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