How can I get my doctor included within my health insurance company’s network?

UPDATED: Jul 29, 2013

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UPDATED: Jul 29, 2013Fact Checked

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Asked July 29, 2013

1 Answer

Many people are disappointed with the health insurance plan they get through their employer because their preferred physicians are not included in the approved provider network. They mistakenly think that the network is carved in stone, so to speak, and they are stuck with seeing a new doctor or paying outrageous costs for keeping the old one. Instead, it might turn out that you can add your own doctor to the provider network, saving you money and benefiting both the network and your doctor's patient base.

The first step is talk to your doctor and find out whether she is interested in joining your network. During the regular course of business, physicians and care centers are invited to join networks frequently, but may not be interested unless there is a cause for them to do so. This is why it is important for you to contact the physician yourself, to let her know you belong to a different network and would like to be able to use her services. It may be that the doctor has already received the necessary forms, or that she has other patients using the same provider, solving your problem for you.

If your doctor agrees and does not have the forms available, contact your insurance provider's member services department. When you speak with a representative, inform that your doctor is interested in joining the network. That person will collect the necessary information from you and pass it on someone in the Provider Relations department. That department will contact the doctor, perform the necessary background and credential reviews, and add the doctor when the process is complete.

Your doctor will not be added until after the insurance company has reviewed him. This review process is performed by a panel of doctors and insurance professionals, and looks at the doctor's credentials, ethics history, part claims for malpractice or other medically related claims, and more. The idea is to maintain a strong and dependable network of caregivers, weeding out potentially problematic members before they get in.

Answered July 29, 2013 by Anonymous

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