Access to quality healthcare services is a vital aspect of life. Unfortunately, the traditional healthcare system is complex, expensive, and restrictive, particularly when choosing a provider. Many individuals outside employer-sponsored plans are limited to HMO network options, with only in-state providers available. In-state HMO networks can pose issues for those who travel, live near state borders, or want to seek care from an out-of-state provider.
However, in recent years, membership-based healthcare options have emerged as a popular alternative without network restrictions. While it may not be immediately apparent for many to consider removing the network requirement from their health plan, it is crucial for those who choose to break free from networks to understand how to choose and work with providers when an insurance company is not picking them for you. Fascinating for many is that this way of healthcare without networks can be more affordable and transparent.
In membership-based healthcare, when the crutch of a network is removed, patients find themselves navigating healthcare as self-pay or cash-pay patients. Navigating healthcare in this manner may sound daunting. Still, the truth is that it's not, and there are numerous advantages to using healthcare in this way. The most significant benefit, only sometimes obvious, is paying less for healthcare services. It starts with cutting the monthly cost in half for a membership-based healthcare plan versus paying the full cost of health insurance without subsidy assistance. (Full cost of health insurance without a subsidy statistics by state)
When we stay in our limited network of providers and have it "covered" by our insurance, we will find that we must meet copay, deductible, coinsurance, and out-of-pocket maximums. "Covered" sounds comforting, but the reality is that we are paying a significant amount of those expenses before the insurance kicks in. Furthermore, we have no idea if what we are paying for those services after the "negotiated" rate is a fair price.
We use the word "negotiate" to describe the perceived help and value we received for our expense insurance premiums. In reality, they have contracted rates with their network of providers, often not the lowest prices available. Many providers will offer a better price for patients with no insurance (self or cash-pay) at a lower rate than their contracted rate with the insurance company (Be sure to read about how self-pay discounts can help lower medical bills). Part of this is due to a direct patient-to-provider relationship created by eliminating third-party billing, which lowers administrative expenses. Although we often think we need the insurance company to do this on our behalf, it is simpler to do it ourselves after getting used to the new process. It also has the effect of transparency, knowing what we are paying as patients and seeing the bill ourselves.
There are two key components to help us gain control of this aspect of our healthcare: willingness to learn as a patient how to navigate healthcare without an insurance network and getting the support we need along this journey. It will help to choose the proper membership-based healthcare to support you along this journey as our healthcare needs change over time. The right support can prevent us from feeling lost and give us the confidence to utilize a more cost-effective transparent healthcare system. We may feel lost, unsupported, and overpay for services. If this is the case, we will likely turn back to insurance and not see the value of navigating healthcare without insurance.
Many of us feel we need an insurance company to provide us with access to providers through their network, "cover" services, and "negotiate" rates for us. The truth is, when we break free from these limitations and utilize alternative options that do not require provider networks, we empower ourselves to improve our healthcare. As a result, we pay less, have more choices, and are able to access better healthcare on our own terms.
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