OHA: Provider Choice

Health Plans

Choice of Providers

Make sure you look in your provider directory from each plan to verify that you have an appropriate choice of providers for you and your family. Understand that the more "managed" your plan is, the more likely you will need to use only the providers listed to receive your benefits. If you have an Indemnity-type plan, you probably will have more choice and flexibility.

Some suggestions:

  • You need to review what doctors, hospitals, and other medical providers are part of the plan.
  • How important is it if your current doctor is not part of this plan?
  • Are there enough of the kinds of doctors you want to see?
  • Do you need to choose a primary care doctor when you sign up?
  • If you want to see a specialist, can you refer yourself or must your primary care doctor refer you?
  • Do you need approval from the plan before going into the hospital or getting specialty care?
  • What happens if your primary care physician leaves the network?