Insurance and Narrow Network Plans
Despite Iowa Ear Center’s best efforts, not every insurance plan is “in network” with our office and providers. Though our office staff will do their best to assist our patients with identifying and navigating narrow network plans, it is each patient’s or patient guardian’s responsibility to check with their insurance company and ensure Iowa Ear Center is in network with their particular plan.
What is a narrow network?
A narrow network is a specific group of plans within one insurance carrier that limits the number of eligible providers more than standard insurance plans. This limitation, while enabling the insurance company to keep premiums low, is often an inconvenience for patients when seeking specialty care. Unlike most insurance plans – where a provider need only provide suitable documentation to complete the credentialing and contracting process to join the network – a narrow network must invite a provider to participate.
How do I tell if I am part of a narrow network?
Typically, narrow network plans are associated with an Accountable Care Organization, or ACO. The two most common ACOs in Iowa are associated with UnityPoint Health and Mercy Medical. If your insurance card carries either one of their logos in the top right corner, you are most likely part of a narrow network.
If you are unsure about whether your plan falls under the “narrow network” category, please contact your insurance company by calling the Customer Service phone number listed on the back of the card. We always advise asking if the physician you plan to see is in network with your plan and if your plan requires a referral before seeking specialty care.
Does Iowa Ear Center participate in any narrow networks?
We are pleased to announce that as of January 1, 2018, Iowa Ear Center is now in network with all Mercy ACO plans. We are also in network with plans associated with UnityPoint Accountable Care and the Wellmark Value Health Plan.
What does it mean for my care if I am out of network?
Dr. Carfrae is the only neurotologist in central Iowa – as such, he can provide services beyond the scope of a regular ENT physician. As a sub-specialty provider, we are often able to obtain an out-of-network benefit exception; this means that the patient will receive in network benefits as care is unable to be provided from any in network physician.
If the insurance carrier is unwilling to grant a benefit exception, you will receive your out of network benefits and be responsible for paying the remainder of the cost.