Participating providers are members of a managed care network and provide medical care and services to clients of a particular health coverage plan. They often belong to a Health Management Organization (HMO) and provide healthcare services for a set cost. Participating providers are common in the health insurance industry and are often members of a Preferred Provider Organization (PPO). The PPO is responsible for managed care and is an organization of doctors, hospitals and other medical care providers. Because the organization has a covenant with an insurance company or administrator, they offer lower rates to the insurance plan’s clients. Participating providers can be doctors, hospitals, laboratories or other healthcare service suppliers.
Family physicians are often participating providers because they belong to a network of doctors who provide medical care to clients of a PPO or HMO. For example, you need to see your family physician on a regular basis, and you are looking for the best doctor. You discuss the issue with your insurance agent who provides you with a list of participating providers. Because your plan allows you to see any of the physicians, all of the doctors on the list are participating providers in your plan. They provide your medical care, and they participate in your HMO or PPO. Thus, your health plan has a number of doctors who are participating providers.
Hospitals, testing labs and other medical facilities may often be termed participating providers. Because most hospitals work closely with health insurance plans, they are often said to participate in a particular network. They participate in your plan and provide you with quality inpatient services. Because hospitals may work with a number of different health plans, they may be participating providers to several HMOs at the same time. There is no reason why a provider cannot participate in more than one HMO or PPO.
Participating providers are the health service suppliers who take part in a particular medical coverage plan. HMOs and PPOs rely on a team of doctors, hospitals, testing labs and inpatient care facilities to provide quality care at reduced prices. All of the medical professionals who are involved in a particular network are said to be participating providers in that particular system. The physicians, hospitals, pharmacies and other medical care providers are all members of the team and offer reduced rates for their services to an HMO, PPO or other organization.