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Table Of Contents
    Types of Health insurance

    2023 Guide to Preferred Health Providers

    What Are Preferred Health Care Providers
    Megan Fraser Fact Checked Updated: 30 November 2023
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    Preferred providers provide Private Health Insurance Policyholders with an additional layer of comfort, quality, and cost savings. The available allied health care providers list may change depending on the chosen health insurance provider. This network of providers is designed to ensure that members receive high quality assistance while providing the service provider with a consistent stream of clients.

    Today, we will discuss the benefits that a network of preferred health providers grants policyholders when seeking professional assistance. From cost savings to rewards and benefits, there are numerous different advantages that a policyholder can gain from understanding how these networks function.

    Key facts

    • Preferred providers are healthcare providers partnered with specific Insurers to provide policyholders additional benefits and rewards for using their services.
    • The preferred network provides policyholders with lowered out-of-pocket costs and, in some instances, no-gap coverage.
    • The disadvantages of the preferred providers’ network are that it provides less flexibility to policyholders when choosing a healthcare provider and higher out-of-pocket costs when using the services of a non-preferred provider.

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    Understanding Insurance Networks

    Understanding Insurance Networks

    To break it down, an insurance network is a list of allied healthcare providers that a Private Health Insurance company has chosen to partner with. This partnership grants the members of the Insurance Provider with additional benefits they may receive when seeking services from these selected providers. 

    Depending on the Health Insurance Provider of choice, these benefits and rewards could take many forms. The insurance network is also not constrained by a single service type but can take the form of partnered healthcare providers across different industries such as dental, optical, physio and more.

    Network Agreements

    When an Insurance Provider decides to partner with a specific healthcare provider, they sign an agreement. These network agreements benefit the healthcare provider and the Private Health Insurance Company. For the provider, they can receive a steady flow of frequent clients. Private Health Insurance Providers can offer their members additional rewards and cost savings that make their policies more attractive.

    Provider Types

    As discussed, preferred providers are not restricted to a specific industry. This means that a Private Health Insurance Provider could partner with multiple providers to ensure their members receive discounts, no-gap assistance, and rewards for visiting these healthcare providers. Some of the partnered provider types that could be offered are:

    Benefits of Choosing Preferred Providers

    A policyholder may notice two main benefits when utilising the preferred providers’ network. These two benefits are cost savings and quality assurance. Members can receive substantially lowered rates when using the services of a preferred provider. In some instances, there may be a total lowering of the services required as a percentage discount, or the provider may have an agreement with the Insurance Provider for ‘no-gap’ assistance. The Insurance Provider will typically provide its members with all the relevant information needed to understand how their preferred network can provide different forms of cost savings.

    Quality assurance is important. Before utilizing a healthcare provider, it can be quite daunting to select a specific facility to assist with your personal health requirements. The preferred network provides members with a great sense of assured quality. Health Insurance Providers will often conduct extensive research on their chosen partners before agreeing to partner with them. When the partnership is formed, it is a physical showcase of the provider’s capabilities and the trust that the Insurance Provider has placed in the services provided by the allied healthcare facility.

    Identifying Preferred Providers

    Provider directories are resources an insurer may provide their members. These directories often list the contact details, locations, and services preferred providers offer. Provider directories are a good way to determine which preferred provider may meet your personal health requirements.

    Verification Process

    When choosing the right provider, it is crucial that a member verifies the provider with the insurer before seeking out the services. To verify a provider, a member must choose the right provider for their needs. Once this has been done, the member should directly speak to their insurer to ensure the provider is a part of the company’s partnered network.

    An additional step that a member could make is to confirm the scope of coverage that will be provided for any services rendered. This confirmation should be with the insurer as well as the healthcare provider. After confirmation on both ends, the member will have enough information to proceed with the service.

    Comparing Providers within the Network

    Choosing the right provider is an important decision. It is crucial to always do some research on the healthcare providers that you are interested in. Sometimes, an insurer will have more than one preferred provider that offers similar services.

    When comparing the two, looking at the potential costs and service coverage is a good way to make the right decision. Customer reviews also assist in understanding the type of service a patient may receive. These two factors play a large role in finding the right service provider that matches a patient’s personal needs.

    Insurers and Their Preferred Providers

    Every insurer has its own unique list of preferred providers. These providers will always attempt to ensure that members of a specific health insurance company receive a great level of care and quality services that match the insurer’s expectations. To find the list of preferred providers, a member can look through their chosen insurer’s online directory or directly ask for assistance from the insurer.

    Pros and Cons of Preferred Providers

    Cost saving.Restricted care.
    Easy claims process.Less service flexibility.
    Quality assurance.Higher out-of-pocket costs when partnering with out-of-network healthcare providers.
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    Hospitals and Doctors as Preferred Providers

    The preferred network is not only limited to Extras cover but can also be extended to specific hospitals and doctors. Preferred hospitals follow the same agreement as preferred healthcare providers and offer members lowered rates and benefits.

    Doctor agreements may provide patients with the options for gap cover and other additional rewards. Understanding your insurer’s preferred network is a good way of ensuring that you always partner with an option that saves on costs and provides security and quality.

    Member Benefits

    Now that we understand what a preferred provider is and how the insurer’s network works, let’s discuss the benefits a member may receive by utliziing these service providers. The main benefits of these agreements are the lowered out-of-pocket costs that a patient may have and the solidified nature of assured quality.

    When members seek out the services provided by one of these preferred facilities, they receive special discounts and gap coverage that they may not receive when receiving services from non-preferred providers. Quality is assured through these networks. The agreement is a bond between the insurer and the provider. This means the insurer agrees with the quality of services provided and urges their policyholders to utilize these services. Members will also receive a higher quality of service that is more coordinated than if they had chosen a provider that is not preferred.

    Choosing the Right Preferred Provider

    To choose the right preferred provider, you must first identify your personal health requirements. When you have identified these personal needs, choosing a provider that directly matches them will become easier.

    After your needs have been carefully identified, you can seek assistance through your insurer’s network search. These network searches are designed to ensure members have all the information necessary to choose the right provider. Making an informed decision on the preferred provider that a patient chooses is crucial, and the decision should not be rushed.

    What not to do when choosing a preferred provider

    When choosing a preferred provider, it is essential to ensure the provider’s network status. This means that a member should check with the insurer to see whether the agreement still stands and what benefits they may gain from utiliziing these services. Choosing out-of-network providers may result in the member paying significantly higher out-of-pocket costs.

    Quality of service is fundamentally important. Oftentimes, we prefer to only look at the cost of the procedure and service. While this is a good way to receive the assistance we need, it is important to also utilize services of a higher quality. Cost and quality should always match one another. 

    Frequently Asked Questions and Answers

    • What are preferred health providers?

      Preferred Health Providers are allied healthcare providers that have an agreement with specific Private Health Insurance Providers. These healthcare providers provide services to members of certain Health Insurance Companies that are more cost-effective, provide more benefits and rewards, and are quality assured.
    • How do I find out if my insurer prefers a provider?

      The best way to ensure that an insurer prefers a provider is to check with the insurer directly. Often, a large amount of information is available that details the preferred providers and services. These resources can often be found on the selected insurer’s website, through newsletters, or by asking a consultant.
    • Can I visit a non-preferred provider?

      Yes, but the downside to visiting a non-preferred provider is that the policyholder may not receive the available benefits and may incur a higher out-of-pocket cost than originally anticipated. It may also be more difficult and less coordinated when receiving care from non-preferred providers.
    • Are all services covered under preferred providers?

      Not all services may be covered under preferred providers. There may also be additional layers to the coverage that a member will receive. A member’s coverage will vary based on the selected preferred provider, the insurance company, and the agreement. Before undergoing any service or procedure, it is essential always to verify the included services.
    • How does choosing a preferred provider affect my healthcare quality?

      Selecting a preferred provider can positively impact the healthcare quality that a patient may receive. This is because the insurer specifically chose the preferred provider for their quality services. The agreement also allows the allied healthcare provider to provide quality services to members of a specific insurance group. Along with the assured healthcare quality, there is a noticeable decrease in out-of-pocket expenses when utiliziing the allied healthcare provider’s services.

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