A network is a group of healthcare providers, including doctors, hospitals and other medical facilities that have agreed to provide services at discounted rates to members of a specific health plan. Networks are designed to manage costs and ensure quality care.
Knowing your network is smart and helps you get the most from your plan.
See how it maximizes your MyPriority plan benefits.
Types of networks
- Health maintenance organization (HMO): an HMO plan requires you to use in-network providers and get referrals from a primary care physician (PCP) to see specialists.
- Preferred Provider Organization (PPO): a PPO plan offers more flexibility, allowing you to see both in-network and out-of-network providers, though at a higher cost for out-of-network care.
- Narrow network: Narrow Network plans offer lower premiums and provide access to quality care within a specific network of doctors and affiliated providers.
What is a provider?
A provider is an individual doctor, clinic, hospital or other health care entity that offers medical services. Providers can be either in-network or out-of-network:
- In-network providers: these providers have contracts with your insurance plan to offer services at reduced rates. Using in-network providers usually means lower out-of-pocket costs for you.
- Out-of-network providers: these providers do not have contracts with your insurance plan. Using out-of-network providers typically results in higher costs, and some services may not be covered at all.
How do I check if my current provider is in network?
It's important to check if your preferred doctors and hospitals are in-network to avoid higher out-of-pocket costs. If you have a MyPriority® plan, there are a few ways to check if your doctor is in network:
- Call your provider directly
- Speak with a Priority Health enrollment specialist
- Use Priority Health's Find a Doctor tool to check a specific network
What happens if I see an out-of-network provider?
Depending on your plan, seeing an out-of-network provider can result in higher costs or no coverage at all. It's essential to understand your plan's rules regarding out-of-network care.
Are there any restrictions on accessing specialists?
Some plans require a referral from your primary care physician to see a specialist. However, MyPriority plans do not require a referral for in-network specialists. Check with your primary care provider to see if a referral is needed.
What if I need emergency care?
Emergency care is typically covered regardless of whether the provider is in-network or out-of-network, but it's important to check your plan's specific rules. It's a good idea to know this information before you need emergency care.
What are the travel implications for my network?
If you travel frequently, consider a plan with a broad network or national coverage to ensure you can access care wherever you are.
Can I switch plans if my network needs change?
You can usually switch plans during the Open Enrollment Period (OEP) or if you qualify for a Special Enrollment Period (SEP) due to a qualifying life event (QLE).
Why is a large network important?
Having a large network, like Priority Health, has many benefits, including:
- Access to care: more options for doctors, specialists and hospitals
- Convenience: easier to find nearby in-network providers
- Continuity: likely includes your current healthcare providers
- Cost savings: lower costs with in-network providers
- Comprehensive coverage: access to a wide range of services
- Emergency situations: higher chance of nearby in-network emergency care
- Flexibility: more choices for switching doctors or seeking second opinions
Why choose Priority Health?
MyPriority members have access to a large network of high-quality primary care providers across Michigan. That – combined with our virtual urgent and virtual primary care options – means members can get care when and where they need it. Plus, you'll get high-quality care with award-winning customer service1.
You get top value with a MyPriority health plan.