Many Northern Nevada doctors are forming new contracts with insurance companies (and terminating old ones). Being on an insurance company’s doctor list or Provider Directory, can make or break a medical practice. As a result of the changing dynamic the Affordable Care Act, doctors are now choosing the insurance companies that they will accept. Doctor’s offices are also choosing if they want to be listed as an HMO or a PPO doctor, and if they want to be listed as a doctor that accepts Obamacare “Exchange” plans. Each of these decisions affect whether or not your physician will work with your plan.
Many clients who came to us in November and December were sure their favorite doctor accepted the insurance company’s plan, just to find out months later their doctor is no longer on “the list”. If choosing your doctor is the most important factor when buying insurance, consider taking these steps:
- Find a FULL list of the insurance companies your doctor accepts. This can be as easy as calling them and asking, but don’t rely 100% on the staff who answer the phone. Usually when I call and ask I hear, “We accept all sorts of insurance”. Most of the time this isn’t true. When I start listing off the insurance companies who we work with (Aetna, Anthem, Health Plan of Nevada, Hometown, Prominence, Sierra Health & Life… just to name a few) I usually don’t get past the H’s. The best idea is to get a list of at least 3 companies who they work with, and confirm if they accept Obamacare “Exchange” plans.
- Go to those insurance companies websites and look up the doctor. Looking up a doctor on an insurance companies website can be tricky. First, you have to be looking at the right Provider Directory. Provider Directory is the industry term for the doctor list. Your doctor might be on one, several or all of the lists. I’ve narrowed down the exact links to the Provider Directories in Northern Nevada. Feel free to use my list. Some insurance companies have several list of Provider Directories. For example, Anthem has 5 provider directories in Northern Nevada:
- PPO Anthem Choice List – Available to employees who buy health insurance through their company.
- HMO The Anthem Pathway – Available to people who buy their plan directly with Anthem (not through healthcare.gov)
- PPO Anthem Pathway – Available to people who buy their plan directly with Anthem (not through healthcare.gov)
- HMO Anthem Pathway X – Available to people who enroll through healthcare.gov
- PPO Anthem Pathway X – Available to people who enroll through healthcare.gov
- Look for plans with the Provider Directory that includes your doctor. The plans won’t usually say outright, “This includes your doctor”. If you have looked up your doctor on the … “Health Plan of Nevada HMO” doctors list, this will give you the best shot of including your doctor.
Just because your doctor is on the Provider Directory today doesn’t mean he or she will be on the list tomorrow. Doctors have the option to dump insurance companies anytime they feel like it. Having said that, doctors can also decide to be listed on several companies provider directories.
HOSPITALS & LARGE FACILITIES
Major facilities like Renown, Saint Mary’s Hospital, Northern Nevada Medical Center will rarely change the insurance companies who they accept. Mid-size organizations (such as Reno Orthopedic Clinic) might change it once every few years. Small doctors offices can decide to stop accepting insurance at any time.
Do you not want to deal with this? Then feel free to contact Health Benefits Associates and we will look up your top 3 doctors for you.