Understanding Your Aspirus Health Plan Network
Knowing Your Plan Type
Before beginning your search for a provider, it’s critical to understand your specific health plan and how it works. Your insurance plan will likely specify a network of providers, which includes doctors, specialists, hospitals, and other healthcare facilities that have contracted with Aspirus Health Plan to provide care at a negotiated rate.
The plans offered by Aspirus Health Plan may vary. Some common types of plans include Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs), though specific plan options vary. Each plan type has its own rules regarding provider choices and how you access care.
- HMOs (Health Maintenance Organizations): Generally, HMO plans require you to choose a primary care physician (PCP) who will coordinate your care and refer you to specialists within the network. Care received outside the network may not be covered, except in emergencies.
- PPOs (Preferred Provider Organizations): PPO plans give you more flexibility. While you are still encouraged to see in-network providers for the best cost, you can also see out-of-network providers, though at a higher cost. You typically do not need a referral to see a specialist.
Defining the Terms: In-Network vs. Out-of-Network
The concepts of “in-network” and “out-of-network” providers are central to understanding your health plan benefits and potential costs.
- In-Network Providers: These are healthcare professionals and facilities that have a contract with Aspirus Health Plan to provide services at a pre-negotiated rate. When you receive care from an in-network provider, your out-of-pocket costs (such as copays, deductibles, and coinsurance) are typically lower.
- Out-of-Network Providers: These are healthcare professionals and facilities that do not have a contract with Aspirus Health Plan. If you choose to see an out-of-network provider, you’ll likely pay higher out-of-pocket costs, as the provider may not have a negotiated rate with your plan. Your plan might not cover any portion of the cost. In certain situations where it is a medical necessity, certain plans may cover some out-of-network services, but that is rarely the case.
The Importance of Staying Within the Network
Opting to stay within the Aspirus Health Plan network is important because it can result in significant cost savings. Choosing an in-network provider means you benefit from negotiated rates, which generally translate to lower out-of-pocket costs for you. In addition, Aspirus Health Plan works closely with its in-network providers to ensure quality and coordinated care. Your PCP, if applicable, can better coordinate your care with specialists who are also within the network.
Verify Your Coverage Details
Before you start your provider search, it’s always a good idea to familiarize yourself with your specific plan benefits. You can find this information on the Aspirus Health Plan website or through your member portal. Take the time to understand your deductible, copay, coinsurance, and the limitations on your coverage. Understanding your benefits will help you make informed decisions when choosing a provider and receiving care.
Easy Steps for Locating a Provider with Aspirus Health Plan
Finding a healthcare provider within the Aspirus Health Plan network is designed to be a straightforward process. Aspirus Health Plan makes it easy to connect you with the care you need, when you need it. The most common method for locating a provider is through the online provider directory. However, you can also seek assistance from member services.
Using the Online Provider Directory
The online provider directory is the most user-friendly and efficient way to find a provider within the Aspirus Health Plan network. Follow these steps to find the care you need:
Accessing the Directory
Begin by visiting the Aspirus Health Plan website. Look for a link or tab labeled “Find a Doctor,” “Find a Provider,” or something similar. Click this link to access the provider directory. The exact location of this link may vary, so you might want to use the website’s search bar, typing in “provider directory” to find it quickly.
Search Options for Finding a Provider
Once you have accessed the provider directory, you will find several options to search for the provider you need. It is important to understand that these features help you refine your search to find the most relevant results for your specific needs.
- Provider Type: Specify the type of provider you are looking for, for example, a primary care physician, a specialist (e.g., cardiologist, dermatologist, or oncologist), or a specific type of facility (e.g., urgent care center or hospital).
- Specialty: Narrow your search by selecting a specific medical specialty or service.
- Location: Enter a city, zip code, or the name of the provider’s facility to find providers in your area.
- Provider Name: If you know the name of the provider you’re seeking, you can enter it directly into the search bar.
- Language Spoken: Filter your search to find providers who speak a specific language.
- Accepting New Patients: Select this option to find providers who are currently accepting new patients. This will help make sure you can find someone to see relatively quickly.
Reviewing Search Results
After entering your search criteria, the provider directory will generate a list of providers that match your criteria. The search results typically display the following information:
- Provider’s name and contact information, including their address and phone number.
- Provider’s medical specialties and any specific areas of expertise.
- The provider’s affiliation with hospitals or other medical facilities.
- Whether the provider is currently accepting new patients.
Provider Profiles
Click on a provider’s name or profile to view more detailed information. This often includes information about their education, training, experience, and any patient ratings or reviews. This information helps to provide context for your provider choices.
Contacting the Provider
Once you’ve found a provider that meets your needs, follow the instructions in their profile to schedule an appointment. You can usually call their office directly. Take the time to ask questions and make sure the provider is a good fit for your needs.
When Calling Member Services
If you prefer to have someone else help you locate a provider, or if you have any questions or difficulties using the online directory, you can contact Aspirus Health Plan Member Services for assistance. You can find the phone number for Member Services on your insurance card or the Aspirus Health Plan website. They can help you search for providers based on your specific needs and preferences, as well as answer questions about your plan benefits and coverage.
- To best assist, be sure to clearly and concisely describe your medical needs, the type of provider you are looking for, and any other relevant information.
Key Considerations in Choosing a Provider
The process of finding an Aspirus Health Plan provider doesn’t stop with just using the directory. Making a considered decision involves weighing a few factors.
The Provider’s Specialty and Experience
When choosing a provider, you want to be sure they have the right expertise. The provider’s medical specialty is critically important. It is important to find someone whose specialty aligns with your needs. In addition, consider the provider’s experience and training, especially if you have a specific medical condition or concern.
Location and Accessibility
Consider the convenience of a provider’s location. Factors to consider include:
- Proximity: Is the provider’s office conveniently located near your home or workplace?
- Transportation: Is the office easily accessible by public transportation?
- Office Hours: Do the provider’s office hours fit your schedule?
- Parking: Is there adequate parking available at the office?
Patient Reviews and Ratings
Patient reviews and ratings can provide valuable insights into a provider’s bedside manner, communication style, and overall patient experience. Aspirus Health Plan may include patient ratings on provider profiles. In addition, you can search for reviews on sites such as Healthgrades or Zocdoc.
Communication and Relationship Building
The relationship you have with your healthcare provider is one of the most important aspects of your health. A good provider should be a good listener, communicate clearly, and make you feel comfortable asking questions and expressing your concerns.
Verify Your Plan Acceptance
This is a vital step that ensures the provider accepts your plan and is currently accepting new patients. Before scheduling an appointment, contact the provider’s office directly to confirm that they are in-network and accepting new patients. You can also call the Aspirus Health Plan Member Services to confirm if needed.
Before Your First Appointment
Once you have chosen a provider and scheduled your first appointment, there are a few important things to do to prepare.
Preparing for Your Visit
Gather your medical history and any medications you are currently taking. Be prepared to share this information with your new provider. Also, bring your insurance card, photo ID, and any relevant medical records from previous providers. Making sure all your information is in order helps ensure the appointment goes smoothly.
Questions to Ask the Provider
It’s important to have questions ready for your first appointment. Some questions to consider asking include:
- What is your approach to patient care?
- What are your qualifications and experience?
- What are your office policies regarding appointments, refills, and communication?
- How do you handle after-hours emergencies?
- How do you coordinate care with other specialists or providers?
What to Do If You’re Not Satisfied
If you are not satisfied with your provider, you have the right to seek care from a different provider within the Aspirus Health Plan network. If you are not satisfied with your provider’s care or experience, do not hesitate to find a new provider. You can use the provider directory to locate a new provider and start the process again.
Troubleshooting Common Issues
Sometimes, even with the most careful planning, things don’t go perfectly. Here are some steps to take if you encounter any issues during the search process.
What if You Cannot Find a Provider
It is possible that, despite your best efforts, you may have difficulty finding a provider that meets your specific needs. Try broadening your search by expanding your location search, or considering less-specific requirements. As another option, contact Member Services. They can help you with any issues and are also able to help you search for a provider.
Dealing with the Provider Directory Issues
If you have any questions or concerns about the accuracy of the information in the provider directory, or any other issues with the directory, please contact Member Services. Member Services can look into the information and correct the issues to reflect the most accurate data possible.
If the provider you are trying to see is not accepting new patients, you can try calling their office and making an appointment. If they are not accepting new patients, then use the provider search to see if other providers in your plan are accepting new patients.
Conclusion
Finding a healthcare provider within the Aspirus Health Plan network can be a straightforward and empowering experience. By understanding your plan, using the online directory, and considering key factors like specialty, location, and patient reviews, you can find a provider that is right for you. When you take control of your healthcare journey, you can feel more confident, more prepared, and ready to work in partnership with your health providers.
The steps described in this guide allow members to connect with doctors, specialists, and other healthcare professionals. Use the tips outlined in this guide to begin your search and start down the road towards better healthcare.
Take the first step in taking control of your healthcare: Find an Aspirus Health Plan provider today and build a strong relationship with the medical professional who is right for you!
