When this matters
Out-of-state care
Medicare Advantage
HMO referrals
Academic hospital visits
Surgery or imaging
Practical steps
- 1Use your exact plan name and member ID, not just the carrier name.
- 2Verify the hospital facility, physician group, anesthesia, lab, imaging, pathology, and rehab separately.
- 3Ask if prior authorization, referral, or center-of-excellence approval is required.
- 4Request the insurer's answer in writing or save the reference number.
- 5Recheck before care if the appointment is months away.
Questions to ask
- Is this exact facility in network for my plan?
- Is the doctor group also in network?
- Do I need prior authorization or referral?
- What is my deductible and coinsurance for this service?
- What happens if part of the care is out of network?
Red flags
- Relying on a carrier logo on the hospital website
- Assuming all doctors at an in-network hospital are in network
- Ignoring prior authorization
- Not checking labs, anesthesia, or imaging
Related hospital profiles
Hospitals where this access task often comes up.
Specialty center
UAB Hospital
Birmingham / Alabama
Open profileSpecialty center
Banner - University Medical Center Phoenix
Phoenix / Arizona
Open profileSpecialty center
Barrow Neurological Institute
Phoenix / Arizona
Open profileNational benchmark
Banner MD Anderson Cancer Center
Phoenix / Gilbert / Arizona
Open profileSpecialty center
HonorHealth Scottsdale Shea Medical Center
Scottsdale / Arizona
Open profileSpecialty center
UAMS Medical Center
Little Rock / Arkansas
Open profileNational benchmark
City of Hope
Duarte / Los Angeles / California
Open profileNational benchmark
Cedars-Sinai International
Los Angeles / California
Open profileSpecialty center
Keck Medicine of USC
Los Angeles / California
Open profile