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Matching doctors and your plan

Matching a doctor with your health plan can be important. Here’s a few tips.

1) One of the trickier parts of the new Affordable Care Act plans is that many Doctor Networks have shrunk or become HMOs. Many of the plans now only cover Emergencies outside their specific Provider Network or Colorado.
2) HMOs, PPOs and doctor networks: A lot of confusion surrounds this area. If you are going to join an HMO and want a specific doctor, make sure your doctor is in that HMO group. Some HMOs have “pods” in the network in which they refer to. You’ll need to select a Primary Care Physician (PCP) for most HMO networks. Each person can have their own PCP. PCPs are generally doctors associated with Family Practice, Internal Medicine, or Pediatrics. Woman can typically go directly to their OBGYN without a referral from a PCP (as long as the OBGYN is in the HMO network.) PPOs (Preferred Provider Organizations) typically have more doctors in their networks and you will not need a Primary Care Physician as you will generally be able to go to a specialist directly. (United Healthcare also lets their HMO people go to any doctor in the network without a referral.) Most PPOs have out of network coverage which allows you to go to ANY doctor but it will cost you extra.
3) Check the Dr. Directory button for each specific plan that you pick. (When You're getting a quote its on the "Details Next" page and then click the "Dr. Directory" button towards the bottom.)
4) Another way to look up Doctors is to Click the Orange Dr. Lookup button at the bottom of the first quote overview page. It will take you to a Connect For Health Colorado website, and you can search by Last name. This website is tricky as when you find a Doctor the Associated Networks are very different than what you think. Cigna now uses the Local Plus network. Anthem uses Pathways, Humana is HMOx, it's best to call us as we can help you make a decision quickly.


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All of us at ColoradoHealth.com

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