Provider Networks

What’s the role of networks in providing high-quality, affordable care?

Provider networks have been a mainstay of private health insurance coverage for more than 35 years — providing consumers with access to a broad range of hospitals, physicians and other providers along with financial incentives for members to obtain medical care within the plan’s provider network. By including hospitals, physicians, and other providers that meet standards set by established accrediting organizations in their networks, health plans work to ensure that consumers have access to high-quality, effective care.

Consumers benefit from peace of mind when receiving in-network care because it assures the provider meets quality care standards and has lower cost sharing and out-of-pocket costs. Moreover, using network providers protects patients and consumers from excessive costs due to “balance billing.” That is, consumers benefit from health plans’ negotiated payment rates to contracted providers and, likewise, participating providers are barred from charging any additional costs to consumers.

AHIP works to ensure that we have a healthy, competitive marketplace so that health plans can ensure the best value and highest quality services for their consumers.

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