What’s in a Network?

It’s open enrollment time for health insurance companies, and the ads for medical plans and hospital networks are thick.

For families that have their health insurance through an employer, there may be a choice between plans and there may not be.

If your plan requires you to select a network, you will be linked to doctors in that network. For patients with ongoing specialty care, it’s important to make sure all of your doctors are in the network you select.

Many primary care doctors belong to more than one network: I belong to Muir Medical Group and Alta Bates Medical Group (which is now Brown & Toland, part of the Sutter network). There are subtle differences between the pediatric specialists available in each network. Part of my job is to track that for my patients so that they can receive the most appropriate care.

The networks are usually listed alphabetically, and sometimes we find children assigned to the network listed first alphabetically–and not always the one you thought you had selected. Do check insurance cards when they arrive to make sure your children are assigned to the correct pediatrician and the correct medical network.

There are hundreds of insurance plans out there, and it seems like we interact with them that many times a day! Whatever information you can grab onto about your plan: network lab, etc, is always a big help. We don’t make the insurance company rules, we just try to help you negotiate your way through them.

Stay well!

About Lisa M. Asta, MD

Lisa M. Asta, M.D. is board-certified by the American Board of Pediatrics and is a Fellow of the American Academy of Pediatrics, for which she is also a Media Representative (she has been interviewed for “Kids Health” on Health Radio, and quoted in Parenting Magazine, USA Today, and the New York Times, among other publications). She is a Clinical Professor of Pediatrics at the University of California at San Francisco and past pediatric chair at John Muir Medical Center in Walnut Creek. She graduated from Temple University School of Medicine and the Johns Hopkins University. Dr. Asta is also a writer whose fiction has appeared in Inkwell, Philadelphia Stories, Schuylkill, and Zeniada. Her essays have appeared in the Journal of the American Medical Association, Hippocrates, the San Jose Mercury News, and The New Physician Magazine. She is an occasional contributor to KQED public radio’s Perspectives series, and has written articles for Bay Area Parent, Valley Parent, Parents’ Press, and Parents Express, as well as online at WebMD.com, Rx.com, and MyLifePath.com. She wrote a chapter in The Field Guide to the Normal Newborn, ed. Gary Emmet, M.D. BabyCenter.com currently has two how-to videos for parents in production which feature Dr. Asta. For more on Dr. Asta’s writing, visit www.LMAsta.com
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