Not All Provider Networks are Created Equal

As an insurance broker, you know it’s critical to compare provider networks in order to present the right plan to your clients. Here are some factors you should consider when looking at differing networks:

Office availability: In a capitated network model, carriers display every participating provider. It might look like a large number of offices, but when you examine the results, some offices are closed to new patients. If your group is new, members won’t have access to those providers. Capitated models limit provider availability to members.

In an open-access network model, if the office is listed, it’s open. That means you’re getting the network only shows providers whose offices are open and accepting new patients. The network might look a bit smaller, but it’s not misleading.

When comparing insurance networks for your clients, make sure you’re comparing apples to apples. Closed offices can skew your data, making the network seem larger than it actually is. 

Updated network: Some carriers update their networks in real-time, so you’re looking at the most up-to-date data. Some carriers do it on a monthly basis or longer. Those networks may include providers who are no longer participating. On-going monitoring of the network is crucial to ensuring the data is as clean as possible with the most up-to-date information regarding provider participation, location, and licensure. Continual credentialing of providers also ensures the network reflects correct office locations.

In order to access carriers’ networks to screen for providers who may not be participating, ask them to give you a list that includes only their active providers. Stay ahead of the curve and help your clients having hassles at the provider office by making sure they have the latest and greatest network data.

Locations vs. unique access points vs. access points: Understanding what makes up a network is also key. And, those features do reflect the quality of a particular network. For example:

• Locations. Offices, regardless of who is in office.
• Unique Access Point. The provider is listed once, regardless of how many offices they practice at.
• Access points. Every provider at every location—the most common way to display a network. So if one provider practices at five different office locations, this results in five access points.

GEO access and disruption report: You should review GEO access and disruption reports, which are good indicators of a network that will be sufficient for your clients. Some questions to ask yourself:

• Are you looking for the largest network for your clients or for specific providers or ZIP codes?
• Are there sufficient providers in that ZIP code?
• Do you want specific providers to be included as a requirement for the network?

Remember, the quality of the network is as important as quantity.

Cost savings for your clients: Consider the value of the network, its cost, and the savings for members. Don’t shy away from a smaller network—it could pose greater cost savings for your clients.

After taking all these things into consideration, at the end of the day, you have to make the best decision to meet your clients’ needs. You should look at all aspects of the networks you’re considering and understand what the network has and doesn’t have. Your clients will appreciate a decision based on solid research and fair comparison.