Finding a provider

A provider network is a list of providers and hospitals/facilities who contract to provide healthcare services to enrolled employees and their covered family members at a discounted cost. That discounted cost is passed to members (you and your covered dependents), who benefit from lower out-of-pocket costs (copays, deductibles and coinsurance) – plus a lower annual out-of-pocket maximum.

On the other hand, you will pay more to use providers and facilities that are not on the list. Those providers are out-of-network and when you use them, you will receive no discount and pay higher out-of-pocket costs.

Bottom line: It pays to use providers in our medical plan’s preferred networks whenever possible.

Two parts of a network: Providers and facilities

Each medical plan network has two elements that charge fees for healthcare – the people who provide the care and the place where care is received.

1. People = provider: The physician, advanced practice provider or other clinician who is providing the service.
2. Place = facility: The location where you are receiving the service. This may be a physician office, urgent care, emergency room, hospital, etc.

It’s important to understand that sometimes a provider may be in-network, but the facility is out-of-network. Or the opposite may be true.

Before you visit a provider, be sure to confirm both they and the location where you are seeing them are included in the health system network or are in-network. If not, it’s OK to proceed with the visit as long as you understand you’ll pay higher out-of-pocket costs for the provider and/or facility fees.

The 3 provider networks in our medical plans

Both medical plans (HSA Advantage Plan and the Signature Plan) offer the same three provider networks:

• Health system network – this will always be your lowest cost
• In-network - This will be higher cost but offers flexibility (HCH Sync Centrus when seeking care in the local KC region and the Aetna nationwide network only when seeking care outside the designated local region)
• Out-of-network – this will always be the highest cost

Read Find a Provider to learn how to check which network your current providers are in and how to find new providers in your desired network.

Our medical plans are designed to encourage you to use our own health system providers and facilities. It is the highest quality and lowest cost for both medical and pharmacy needs. Using the health system network ensures you get the best care while helping manage costs for the organization and you.

When you choose a provider or facility in the health system network, your annual deductible, coinsurance and copays are lower compared to in-network providers and especially to those who are out-of-network. Your annual out-of-pocket maximum is also much lower.

The health system network includes health system facilities for covered services within The University of Kansas Health System in the Kansas City metro area, as well as Great Bend, the St. Francis campus in Topeka, and LMH Health/Lawrence Memorial Hospital.

Remember that networks are made up of both facilities and providers. As the health system expands, the health system network is growing to provide more access to care, while also becoming more complex. Some providers practicing at health system facilities are not part of The University of Kansas Physicians (UKP) organization, which means they are not part of the health system network.

Bottom line: Do your homework to understand which providers AND facilities are in which provider network before you receive care (when possible). Once the service is complete, you are accountable for paying the associated fees – the health system, Benefits team or Luminare Health cannot change the charges.

Flexibility and choice are important, so our medical plans include an in-network option that still helps you save money. You may be wondering how in-network is different from the health system network. These are providers and facilities outside of our health system that have agreed to accept an approved amount for their services.

So, if an in-network doctor charges $150 for a service and the approved amount with our medical plans is $90 – you save $60. You’ll also pay a lower annual deductible, coinsurance and copays compared to using out-of-network care. Your out-of-pocket maximum is also significantly lower compared to using out-of-network care.

Both the HSA Advantage and Signature plans offer access to a variety of in-network providers and facilities for covered services through our contracted networks.

• Kansas City region: Through the HCH Sync Centrus network, both medical plans give you access to more than 6,100 providers in Kansas and Missouri. This area is designated in blue on the map.
  

• • When you are seeking care in this designated region, you must use a health system provider or a provider within this network to avoid out-of-network charges.
  • The counties in the designated blue area are:

    Kansas:

    • Atchison
    • Douglas
    • Jefferson
    • Johnson
    • Leavenworth
    • Linn
    • Miami
    • Shawnee
    • Wyandotte

    Missouri:

    • Bates
    • Caldwell
    • Cass
    • Clay
    • Clinton
    • Jackson
    • Lafayette
    • Platte
    • Ray

• Greater Kansas and nationwide: Both medical plans offer in-network coverage via the Aetna nationwide network.  This network should be used ONLY when seeking care outside the Kansas City region designated in blue on the map. Some examples of who should use this network include:
  • Those living and/or working in the Great Bend area and greater Kansas.
  • Remote workers outside the Kansas City region.
  • College students living outside the Kansas City region.
  • Those traveling outside the Kansas City region.

CAUTION: When reviewing providers in the Aetna nationwide network, you will find some listed who are not included in the health system or HCH Sync Centrus local network. If you use these providers, it will be considered out-of-network. If you need care within the designated local network, you must use the search tool for the health system/HCH Sync Centrus local network. Bottom line: The Aetna nationwide network should be used ONLY when seeking care outside the designated local network.

For care in the designated local network

When you need care in the local Kansas City region network shown in blue on the map, use this search tool to find a health system provider or an in-network provider.

Health system network and local HCH Sync Centrus network for designated Kansas City local region

Search Providers

Note: The HCH Sync Centrus search tool remains under development. Before Jan. 1, a designation will be added indicating which providers are in the health system network and which are in-network.

Until then, take the following steps to find a provider in the health system network:

1. Go to KansasHealthSystem.com
2. Click Find a Doctor

Look for those with this identifier:

Simply put, receiving care from out-of-network providers is your most expensive option. You will pay more for getting care in multiple ways:

• The amount you’ll be charged is likely higher than the discounted rates offered in the health system network and by in-network providers. This is because out-of-network providers and facilities (such as HCA and Saint Luke’s) have not agreed to accept an approved amount for services.
• Your share of the cost is more with higher coinsurance and/or copay amounts.
• You’ll need to meet a higher – and separate – deductible for out-of-network care.
  • Any money you spend on out-of-network care does not count toward your deductible. This makes out-of-network care even more costly.
  • One exception: Coinsurance for emergency room visits is applied to the in-network deductible. This is to ensure cost isn’t a barrier when care is needed most.
• You’ll have a higher – and separate – out-of-pocket maximum. It is calculated separately from the expenses that apply toward the out-of-pocket maximum for health system and in-network care.

Given the big impact on your budget, it’s important to make sure both your provider and facility is in-network – or better yet – in the health system network for the absolute lowest cost to you.