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Network Doctors in Medical Insurance

What is a network doctor? What are the advantages of seeing an in-network provider?
Last update:
9th December 2022
alea
Reviewed by a licensed advisor
doctor holding stethoscope
doctor holding stethoscope
What is a network doctor? What are the advantages of seeing an in-network provider?
Last update: 9th December 2022
Contents

What is a network doctor?

A network doctor is a doctor who is part of your insurance company’s network of healthcare providers. Many insurance companies establish provider networks from which their customers can seek healthcare. These networks include doctors, hospitals, laboratories, clinics and specialists. For localized insurance plans in Hong Kong, these networks usually cover Hong Kong only. For high-end international health insurance plans, these networks are global.

Medical service providers are carefully vetted before they are added to an insurance company’s network. Once they join, they enter into a contract with the insurance company. As part of the contract, doctors must provide services at a certain rate to the insurer’s patients.

Other terms you might see for “network doctor” are “in-network provider” and “panel doctor.”

Benefits of seeing a network doctor

The advantages of seeing a network or panel doctor means you will often pay less or nothing at all.

  • Some insurance policies give you access to network doctors who will charge you a lower or discounted rate.
  • Some insurance policies will have you pay just a small deductible or copay when you see a network doctor. This helps keep your premiums lower.
  • Some insurance policies will let you enjoy cashless access to treatment, where the insurance company pays the provider directly for the treatment if that provider is in the insurer’s direct billing network. This way, all of the paperwork is handled by the insurance provider, and you don’t need to file reimbursement claims.

Note: Some insurance providers will only provide coverage for treatment administered by a network doctor. Be sure to check the terms and conditions of your policy!

Are all doctor networks the same?

Doctor networks or provider networks will vary based on your insurance company and the terms and conditions of your policy. Sometimes this is related to your premiums.


Localized plans

  • Premiums: Lowest premiums
  • Network: Small, often restricted to low-cost providers and public hospitals
  • Coverage: Lower limits and benefits

Mid-tier plans

  • Premiums: Vary depending on coverage options
  • Network: Larger network, including some private facilities
  • Coverage: Higher limits, preventing access to top-end facilities; may require copays or deductibles paid out of pocket

High-end plans

  • Premiums: Most expensive
  • Network: Global and comprehensive, with access to private medical facilities worldwide; high-end plans usually have a direct-billing network
  • Coverage: High or no limits, often with cashless treatment (insurer pays provider directly; you don’t need to file claims)

Filing claims with network doctors

The claim process when you seek treatment with a network doctor depends on your policy. Read over your policy documents or check with your insurance provider or broker to find out how seeking treatment from a network doctor works.

At the top end of the scale, network or panel doctors are a part of the insurance company’s direct-billing network, allowing you to enjoy cashless treatment. Usually, all you have to do is show the medical staff your health insurance card, and they will take care of the payment. No need to file a claim!

On the other hand, if your doctor is not part of a direct billing network, then your outpatient or inpatient claims process might look different. This will depend on their contracts with the insurance company. Below you will find examples of different claims procedures for network doctors.


Claims for outpatient services

  • You pay a discounted rate but cannot file a claim, OR
  • You pay coinsurance and file a claim for the rest, OR
  • You pay the full amount and submit a claim for reimbursement, OR
  • You don’t pay anything; your insurance provider pays the clinic directly because the provider is part of the direct-billing network (cashless settlement).

Claims for inpatient services

  • You pay the full amount and then submit a reimbursement claim, OR
  • You pay a deductible and file a reimbursement claim for the rest, OR
  • You don’t pay anything; your insurance provider pays the hospital directly (cashless settlement).*

*If you need to be admitted to the hospital for surgery or treatment, it’s a good idea to let your insurance provider or broker know so they can liaise with the hospital and assist you in getting a pre-authorization for the procedure and set up a guarantee of payment. The hospital will send the bill directly to the insurance provider, provided that the fee is within the limit per your plan.

Also note that you might need a referral letter in order for your insurer to cover certain things such as diagnostic scans, specialist care, and physiotherapy.

Looking for health insurance?

Doctor networks for health insurance providers in Hong Kong

It’s always best to contact your insurance provider or broker directly to get the most up-to-date information about your doctor network. Nonetheless, for your reference, here are links to information about network doctors for Alea’s health insurance partners.

No responsibility is accepted for any inaccuracies, errors or omissions.

FAQ

Am I required to visit a network doctor for my insurance company to cover the cost of treatment?

That depends. Some insurance companies will only provide coverage if you see a network or panel doctor. Other insurance companies will cover you even if you see an out-of-network doctor; the only catch is you might have to pay out of pocket and then file a reimbursement claim later.

Check your policy benefit terms or contact your insurance provider or broker to get confirmation.

Why is it better to see a network doctor?

Network doctors have agreements with insurance companies to provide services at lower rates. Seeing a network doctor means you can get treatment from a qualified and vetted doctor for a less expensive price than if you were to see an out-of-network doctor for the same treatment. Moreover, if the network doctor belongs to your insurer’s direct billing network, you can enjoy cashless treatments.

Can a doctor be in multiple provider networks?

Yes, a doctor can be in multiple provider networks. If you are not sure if your doctor is in your insurer’s network, you can check directly with the insurance company.

How do you check if your doctor is in-network?

There are several ways to check if your doctor is in-network.

  1. Check your insurance company’s website or app. Note, however:
    1. Some of the information may be out of date.
    2. Some insurance companies may also list doctors who are outside of their direct billing or panel networks in their online search tools. (It can be confusing!)
  2. Check your doctor or healthcare provider’s website.
    1. Note that the information on their website might also be out of date.
  3. Call your doctor or healthcare provider and ask them directly.
  4. Call your insurance company and ask them directly.
  5. Call your insurance broker or agent and ask them directly.
  6. Ask your doctor or healthcare provider in person before your appointment.

What does in-network mean?

A doctor, specialist or other healthcare provider is considered “in-network” if they accept your medical insurance plan.

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This article was independently written by Alea and is not sponsored. It is informative only and not intended to be a substitute for professional advice and should never be relied upon for specific advice.