Florida Health Plan Consumer Information

Obtaining Information on Health Plan Provider Networks

With traditional indemnity or fee-for-service health insurance plans, members may seek care from any available provider, such as, doctors or hospitals. Under managed care health plans, like Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs), your choice of doctors and hospitals is limited. Providers that have contracted with a managed care plan for services are collectively called a network. The managed-care network controls the delivery of health care services. Members of HMOs must use the HMO’s network of providers, while members of PPOs will pay more in coinsurance for receiving care from a non-network provider.

It is important for members and prospective members of managed care plans to determine which health care providers are in their network. Due to the constantly changing membership of providers within a network, the Agency for Health Care Administration does not issue network provider lists. Instead, the Agency recommends the following:

• Contact the health plan directly, either via the Internet or by calling or writing the plan.
  
• You can find the website address for all health plans displayed in the Florida Health Plans Consumer Information website by clicking on "Health Plans Available in Your County", then click on the health plan's name.
• If you visit a health plan's website, look for links that display lists of participating physicians, hospitals or pharmacies. Sometimes you will be asked to search for a specific provider's name.
• You may also call or write the health plan to request a list of its network providers. Visit the plan's website and look for "Contact Us" to find the plan's telephone number and mailing address.
• Plan contact information may also be obtained from brochures published by the Florida Department of Financial Services. Call the Department's Consumer Helpline toll-free at (800) 342-2762 for more information.