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Provider Directory/Network

The provider directory is a database of the hospital network, clinics, treatment facilities, doctors, and other care providers that a particular plan. Particularly relevant to Premium Coverage Plans (also known as Comprehensive Coverage Plans), provider networks offer discounts or waivers of coinsurance and co-pay costs. Common discounts are 90%-10% splits of the coinsurance (with the insurance company paying 90%, and the remaining 10% being left to the insured) or in some cases a complete waiver of the co-pay as a whole. Provider directories are closely related to PPO plans (Preferred Provider Organization). PPOs allow for a wider range of doctors to choose from, allowing the insured to stay within its provider directory (again with the incentives of waivers and discounts) or seek treatment from any doctor (but without any discounts or waivers). PPOs also allow patients to see a specialist without a referral from a Primary Care Physician. Direct access to specialists is good for people who have chronic illness, or should there be a need for urgent care.


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