What is a Participating Provider of Medical Care?

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Participating (par) providers are healthcare providers who have entered into an agreement with your insurance carrier. Your insurance carrier agrees to direct “clients” to the provider and, in exchange, the provider accepts a lower fee for their services. This statement is correct for medical insurance companies with contracts with the medical provider. The contract defines the word “participating”.

There are many insurance companies or insurance plans that do not have contracts.

Participating means to share, take part in, partake.

What is it called if your medical provider fills out all insurance forms, submits the claim, and accepts the insurance payment, as payment in full? The medical provider is participating with your insurance and you.

You may assume by asking a doctors office “Do you take my insurance?” and the office replies “yes” they are participating with your insurance. That is incorrect! This only confirms that they will take/accept your insurance company’s payment and submit your claim to your carrier. They do not necessarily have a contract with your carrier.

Half the time the medical provider’s office can not be certain if your particular plan will cover your services. Even if, the doctor’s office calls for verification, a recorded message is played after the insurance company’s’ determination – “This is not a guarantee of payment.” Insurance companies are always changing contract terms and providers in their networks. To be safe, you should always check your insurance carrier’s provider directory first!

Ask a healthcare provider if they are contracted with your insurance carrier. Get the insurance company to verify coverage to you personally. There are providers who play this word game. To be sure, the insurance industry is playing the same word game. Is this unethical and confusing? Maybe, the insurance industry should replace the word “participating” with “contracted”.

Without a contract or written statement in place, there is nothing to protect you. Please be careful!

Dr Brady Works with Your Insurance

Dr. Brady is a participating (contracted) provider with many of the most popular insurance companies. Our office will work with insurances plans that we do not have a contract. In fact, many do not. Our office will work (participate) with an insurance company if they will work with us. Our office tries to be active in helping you determine your insurance company’s responsibility in your medical care. In the light of this, we have compiled a listing of insurance companies we commonly work with. Check it out here.