Imagine this: One of your employees — let’s call her Ann — met with her primary care provider (PCP) who recommended she have a specialized surgery, but he referred her to a specialist who's out-of-network. Not only is Ann unfamiliar with the health network and the kind of care she will receive, but the surgery comes with an alarming price tag.
Ann may come to you — the company’s HR or benefits administrator — and ask for help. And to ensure you are the 'health plan hero' to your employees, offering a limited network plan to your employee benefits package can arm you with an answer to Ann's question.
But first, let’s set the record straight: Offering a limited network plan doesn’t mean employees like Ann receive less health insurance coverage. In fact, this tailored solution is a great way for employees to receive high-quality, coordinated care at an affordable price. And through these plans, providers within the network have a clearer picture of what’s going on with the overall health of your employees.
Limited network plans also help your business, too. Here’s how:
- Help improve your employees’ health. Limited network plans take your employees' complete health into the picture to emphasize safer, more effective care.
- Save your organization money. It’s simple — when your employees’ health improves, the less they use health services.
- Provide coordinated care. Receive compassionate care from specialized services, on-demand services within a community-based network. Limited network plans focus on remarkable patient-focused care and services.
Now that you know the advantages of adding a limited network plan to your company, the next question is where to start?
Look no further than the Wellmark Value Health PlanTM it's a partnership between Mercy Health Network and Wellmark Blue Cross and Blue Shield to improve your employees’ experience and their health, and increase the quality of care they receive while driving down costs.
With the Wellmark Value Health Plan, when Ann is recommended to an out-of-network doctor, the Wellmark medical team reviews the request, researches the specialized request and finds a doctor within the Wellmark Value Health Plan network. This ensures Ann — and many of your other employees — receive the right care at the right place, for the right cost.
Our medical review process keeps members like Ann in network to avoid unnecessary out-of-pocket network cost shares.
Ann needs to have a specialized surgery. Her doctor, Dr. Green, refers her to an out of network doctor and submits the request to Wellmark.
The Wellmark medical team reviews the request and researches the specialized procedure.
They find a doctor in the Wellmark Value Health Plan network, who can also perform that surgery to make sure Ann gets the right care at the right place for the right cost.
Wellmark contacted Dr. Green to share this information and he agrees to refer Ann to the in-network doctor, which means lower out of pocket costs and less travel for Sally.
Interested in finding out if a Wellmark Value Health plan would work for your employees? Contact your authorized Wellmark representative for more information.