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Health Insurance Networks

As a lifelong Colorado resident, I am aware there are major differences in the geography and population in this state. While over 85 percent of Colorado residents live along the Front Range, from Colorado Springs to Fort Collins; there are numerous communities that are located on the Western Slope, mountains and Eastern Plains.

Because I have lived all over the state, I know that getting into and out of the mountains or to a rural area can be difficult. That is why I work with our cilents at Colorado Health Insurance Brokers to know where they live and their coverage needs. Experience has taught me that the coverage and availablity of providers varies as do the plans that cover them.

This is a very important consideration that is overlooked my many people as they focus on price and coverage options when shopping for individual and small group health insurance coverage. While most insurance companies have strong networks in the metro Denver, Fort Collins and Colorado Springs areas; the same can not be true for the mountains, the Western Slope and Eastern Plains. Some networks are more regional and may not have a selection of providers in some areas, or none at all!

Reviewing provider networks to ensure there are healthcare professioanls in your area is very important. On a more personal level, doctor network participation varies; so it may be even more important to verify network coverage if you are changing health insurance providers and want to make sure your doctors participate in a particular network. This can be accomplished by loging onto a provider website and using thier “Dr Finder’ or “Provider Finder” lookup systems. It may also be easier to simply call your doctor or other healthcare provider and ask them if they take a particular type of insurance. This will prevent the surprise of finding out your doctor does not take your health insurance when it comes time to actually needing to use your policy.

Another component of health insurance of which everyone should be aware are the levels of In-Network versus Out-of-Network coverage. While the goal is to use In-Network providers and services; you may have to use an Out-of-Network provider in emergency situations or to purchase specialized treatment of services from a provider that does not participate in a particular health insurance network. While coverage for In-Network services varies by plan; the range of coverage for Out-of-Network services can vary substantially between plans and may not be covered at all.

Health insurance buyers should at least be aware of the general differences in coverage for In-Network versus Out-of-Network under your existing plan, or the ones that you are considering for purchase. If a person, or family has specific needs; you may need to research now competing plans cover that condition. Common coverages that vary widely between in and out of network coverage as well as among different plans and include; mental health, preventative care, lab and x-ray services.

Research the options online and ask your broker questions about your which plans may provide the best solution for you. This due dilligence will provide you with the appropriate coverage for your needs and help prevent paying more than necssary for your health insurance coverage.

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