California Individual Health Insurance Networks

California individual health insurance plans fall under two broad categories. Either you can opt for managed care or you can select FFS (fee for service) and indemnity plans. California individual health insurance plans that fall under the managed care schemes require you to stick to a list of doctors and health care providers - this is also known as a provider network. You need to select a plan and work with the doctors and hospitals associated with your plan.

Provider Networks for California Individual Health Insurance Plans

A provider network is, in essence, a win-win for all stakeholders. A managed care California individual health insurance network allows you, the insured party, to avail of low cost medical help and facilities. A provider network brings in big-ticket business for health care specialists, doctors, and hospitals. It also allows insurance companies to remain competitive.

Health care specialists and providers first need to enter into an agreement with a company offering California individual health insurance plans. Under this contract, the doctor or hospital offers services at subsidized rates and in exchange, the company sends large volumes of patients their way. Depending upon the discount they offer, service providers are selected for different plans. Along with discounts, the health care provider also has to prove their worthiness in the form of qualifications, experience, certifications, and so on.

Different Provider Networks for California Individual Health Insurance Plans

HMO or Health Maintenance Organization has low cost California individual health insurance plans, with low percent of co-pays, almost negligible or no deductible, and generally without coinsurance. In exchange for this, you need to remain within the network. You select a PCP or a Personal Care Physician and use their referrals in order to get medical services. If you prefer to consult someone outside the network then you cannot claim coverage for those expenses.

PPO or Preferred Provider Organization are almost similar to HMO. However, here you are given the option of straying outside the network. While this option is given to you the idea is to remain within the network as much as possible. But if you require specialized care and if it is absolutely unavoidable, then you may consult specialists outside the network. However, you must then be ready to pay higher deductibles, coinsurance, and co-pay amounts.

Selecting a California Individual Health Insurance Provider

Selecting a provider can be a challenging task so ask friends and family for their opinion and recommendations. Find someone who lives close to you and whose timings are convenient for you. This doctor must be affiliated with your network of hospitals and of course you must have double-checked his credentials and qualifications before you begin consultations under your California individual health insurance plan.