Provider network

Of the four questions in the survey, consumers were most likely to understand whether or not their plan had a provider network. About 80% of individuals surveyed correctly answered this question.

If your health plan has a provider network, your insurance policy or certificate of coverage will explain the procedures you are required to follow in order to receive covered benefits. You will also receive a provider directory, which lists the hospitals, doctors, and other providers in the network. You should receive an updated provider directory annually.

Before making an appointment with a doctor, check the most current provider directory to determine if the doctor is associated with your plan. Be aware that doctors may leave the network during the year. The agreements between your health plan and the network providers are separate from your health insurance contract. Therefore, you should also call the health plan's customer service department or ask the doctor's staff when you make an appointment to verify that the provider is still part of the network.

If the doctor you are seeing leaves the network during the year, you may be able to continue your treatment with that doctor for a period of time. Managed care plans in Wisconsin are required to allow you to continue care with your primary care provider until the end of the plan year and to allow you to continue treatment with a specialist for up to 90 days. If your doctor leaves the network, your health plan should provide you with specific information about your options.