We understand you have questions. Our healthcare experts are here to help.

What is a healthcare network, and why is it important?
A healthcare network is a group of doctors, hospitals or other healthcare providers that accept a certain healthcare plan. Ensuring that your healthcare provider is in-network on your healthcare plan will help you save the most money on your care.

What is a provider?
A provider is a licensed healthcare facility, program, agency, doctor or health professional that delivers healthcare services.

What is an HMO, and how does it work?
A Health Maintenance Organization (HMO) is an organization—and benefit plan option—that provides healthcare coverage to its members through a network of doctors, hospitals and other healthcare providers. Generally, members with HMO plans require referrals from their PCP for specialist care, and the network providers may be limited to a specific geographical area.

What is a PPO, and how does it work?
A Preferred Provider Organization (PPO) is a healthcare plan that supplies services at a higher level of benefits when members use contracted healthcare providers (in-network); these plans offer more flexibility to choose the doctors, hospitals and other healthcare providers you use to get care. What are benefits? Benefits are healthcare items or services covered by a healthcare plan. Your healthcare plan may sometimes be referred to as a “benefit package.”

What is a PCP?
A Primary Care Physician (PCP) is the physician you choose to be your primary source for medical care. Your PCP coordinates all your medical care, including hospital admissions and referrals to specialists.

What does it mean to be in-network?
This means that doctors, hospitals or other healthcare providers have contractual agreements with the insurance company to offer or negotiate services at a lower price—saving you money.

What does it mean to be out-of-network?
Services you receive are considered out-of-network when you use a healthcare provider that does not have a contract with your healthcare plan. Services by out-of-network providers may not be covered by your healthcare plan or may be covered less comprehensively.

What is a Claim Statement?
A Claim Statement—previously called the Explanation of Benefits (EOB)—is one of the most frequent communications that you’ll receive from your healthcare plan. Whether you receive a hard copy in the mail or a digital version online, this important document clearly summarizes any recent healthcare services you received, and it may provide an overview of your benefits usage to date.

What are the codes on my Claim Statement for?
These are called Current Procedural Technology (CPT) codes and were created by the American Medical Association to construct a universal language for standardizing how the healthcare industry describes medical procedures. Providers use these codes to simplify billing for services, which you will see on your claim statement.