Switching from PPO to HMO but already seeing a specialist

[Jim Wright]

I hear what you both are saying regarding calling the carrier. Personally, I call both, but consider this about calling the carrier. Carrier websites/database can be notoriously behind. So it is possible that the carrier data reflects participation when in fact the provider had already opted out.

In general, the system is not perfect. If it were me and the carrier website said they were in network, I would trust that more than the person at the front desk. The people at the desk also don't typically understand different networks under the same carriers. They may say "yes, we take UHC" but it turns out they only take group and the person asking has an individual plan.

Again, the system isn't perfect but it's rare for providers to jump in and out of networks so frequently that no one knows their status.

 

[Newby]

In general, the system is not perfect. If it were me and the carrier website said they were in network, I would trust that more than the person at the front desk. The people at the desk also don't typically understand different networks under the same carriers. They may say "yes, we take UHC" but it turns out they only take group and the person asking has an individual plan.

Again, the system isn't perfect but it's rare for providers to jump in and out of networks so frequently that no one knows their status.

You hit the nail on the head. Most of them think along the lines of brands that they know they take rather than types of networks.
It works in reverse also. One of my doctors had signs hanging up saying they do not accept any Humana plans. I taught them that they do take Humana Medicare Supplements. They do not take their HMO or PPO plans.