Network or reimbursement agreement: Which to choose in health insurance?

What are the advantages and disadvantages of the conventional network and reimbursement?

When choosing health insurance, one of the main decisions to make is to opt for a plan with a conventional network or a reimbursement system. Both modalities offer advantages, but differ in how medical expenses are paid and reimbursed.

What is a health insurance plan with a network of providers?

Insurance with a network means the insured can use a specific list of hospitals, clinics, and health professionals with an agreement with the insurer.

With the network, these are the advantages you can access:  

• Reduced or nonexistent payments - The insured only pays a part of the cost of the consultation or treatment. In some cases, there is no additional payment at all.

• Easy access - Just schedule the appointment or exam directly at an entity belonging to the network.

• Simple process - No need to pay the total amount upfront and wait for reimbursements.

However, with the conventional network, you have a limited choice, restricted to doctors and institutions that are part of the insurance network, as well as potential wait times requiring availability in the network.

What is a health insurance with reimbursement system?

With the reimbursement system, the policyholder can choose any doctor, clinic, or hospital, even if they do not have an agreement with the insurer. The amount paid will be reimbursed later, either in full or in part, according to the insurance contract.

With the reimbursement system, here are the advantages you have access to:

• Total freedom of choice - you can go to any doctor or healthcare facility, inside or outside the insurance network;

• Specific specialties - Useful for those who already have trusted doctors who are not part of the conventional network.

• High refund possibilities - Some insurances refund up to 100% of the amounts paid.

However, as disadvantages, the reimbursement system requires the full payment of the expense at the moment, only being reimbursed later by the insurance company. Depending on the insurer, the reimbursement process may also take several weeks.  

In addition, the refund may be subject to maximum caps per year or per medical act.

Read more: Health Insurance: Coverages, exclusions, and advantages

The choice between a network and reimbursement depends on your needs. If you prefer simplicity and reduced costs, the network may be the best option. If you value freedom of choice and are willing to advance payments, the reimbursement system may be more advantageous.

Some insurances offer mixed plans, combining both systems. Before signing up, compare the conditions, refund values, and the network of providers available to ensure the best choice for you. For this, you can hire the free service of an insurance mediator, like Poupança no Minuto, that handles all the bureaucracy and negotiation of conditions with insurers. [https://www.poupancanominuto.com/seguros]

Read also: What distinguishes health insurance, health plan, and health card?

Do you want to hire your health insurance, getting the best policy without worrying about anything? Contact the agents of "Poupança no Minuto" at https://www.poupancanominuto.com/contacto and access the service for free!