Our Provider Network & What You Should Know

What’s a provider network?

• A provider network is a list of the health care providers, doctors, and hospitals that FHCP has contracted with to provide medical care to our members, as “in-network providers.”
• Any provider that is not contracted with FHCP and doesn’t participate in our network is called an “out-of-network provider.”

How can I see if my doctor is in an FHCP network before I choose to join FHCP?

• When you compare plans, you can search for your doctor and medical facility by searching Find A Doctor/Facility.
• As you compare plans, you can feel free to contact us with any questions so we can tell you if the plan you select includes those doctors or facilities in-network. FHCP has different networks for different plans, so make sure you’re searching the provider network of each specific plan you compare.

How do different types of plans use provider networks?

Your care may be covered only when you see an in-network provider, depending on the plan you buy. If you choose to receive care from an out-of-network provider, your care may not be covered, or you may pay more.

For HMO plans: If you use a doctor or facility that isn’t in your plan’s HMO network, you may have to pay the full cost of the services you receive. Those with an HMO plan should seek coverage from providers who work for or contract with FHCP. An FHCP HMO benefit plan typically doesn’t pay for any out-of-network care except in an emergency or urgent situation. It is important that you have a primary care physician (PCP), and your PCP will refer you to see specialists.

Why do some plans cover benefits and services from in-network providers, but not out-of-network providers?

When a provider is in-network for your plan, it means they have agreed to offer benefits or services to the members at previously stated prices. The health care provider will generally offer a covered benefit at a lower cost to the in-network members. Those without insurance or those who have an insurance plan with an out-of-network provider may have to pay full-cost.

If you use an out-of-network provider, you may have to pay the full cost of the benefits and services unless it is an emergency service. For out-of-network provider emergency services, FHCP will cover the cost at the same price as if you used an in-network provider.