I moved to a new city. How do I ensure my health insurance covers my preferred doctors and hospitals, and what should I do if they're not covered?

I am 25 and recently moved to a new city. I am trying to understand how network providers work with health insurance plans. How can I find out if my preferred doctors and hospitals are covered under my plan, and what should I do if they're not?

Reply by Anuradha Sriram, Chief Actuarial Officer, Aditya Birla Health Insurance 

Understanding the network of healthcare providers associated with your health insurance plan is crucial for maximizing your coverage. Here are steps you can take to find out if your preferred doctors and hospitals are covered under your plan, and what to do if they're not:

Reach out to the insurer/Customer Service: Reach out to your insurance provider's customer service helpline. Customer service representatives can provide you with information about the network hospitals and doctors covered under your specific health insurance plan.

Read the Policy Documents: Refer to your health insurance policy documents, including the policy booklet and network provider list. This document typically includes a comprehensive list of hospitals and healthcare providers that are part of the insurer's network.

Visit Network Hospitals Directly: If you have specific hospitals or healthcare facilities in mind, you can directly visit them or contact their administrative offices. They can confirm whether they are empanelled or network providers for your health insurance plan.

Use Insurer's Mobile App: Some insurance providers have mobile apps that allow you to check network providers on the go. You may find features within the app that help you locate nearby network hospitals and healthcare professionals.

Check for Updates and Changes: Keep in mind that network provider lists can change over time. Insurers may add or remove providers from their network. Stay informed about updates and changes to ensure you have the latest information.

If your preferred doctors or hospitals are not covered under your health insurance plan:

Consider Out-of-Network Coverage: Some health insurance plans offer coverage for treatment received at non-network hospitals, but the reimbursement may be lower. Review your policy documents to understand the terms and conditions for out-of-network coverage.

Explore Reimbursement Claims: If you receive medical services at a non-network facility, you may need to file a reimbursement claim with your insurance provider. To support your claim, keep detailed records of all medical expenses, including bills, prescriptions, and diagnostic reports.

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Request for Empanelment: If your preferred healthcare provider is not part of the network, you can inquire with your insurance provider about the possibility of adding them to the network. Some insurers may consider empanelling new healthcare facilities based on demand.

Consider Network Hospital Alternatives: If your preferred providers are not covered, explore alternative network hospitals or healthcare professionals within the insurance network to ensure you can access cashless services.

When selecting a health insurance plan, gathering information about network providers and coverage details is essential. Being well-informed about the network facilities can help you make informed decisions about your healthcare and financial well-being.

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