Network Physician, Provider and Hospital Selection

The factors used when considering providers for our networks include:

Quality of Care

Before providers join our networks, we check to see that they have the appropriate education, licensure and training to provide quality care.

We require that all providers meet our stringent credentialing standards, which include the verification of licensure, education, training and malpractice and sanction history prior to joining our network.

The ongoing quality monitoring of physicians and providers is accomplished by checking for licensure and sanctions, and investigating, tracking and monitoring member complaints about quality of care.

Member Experience

We listen carefully to our members’ feedback about physicians, providers and hospitals after they have joined our networks. We employ various survey methodologies and carefully review and investigate any member complaints.

Location

Easy and prompt access to the care you need is important. That’s why we work hard to include network providers in the areas we serve so that you can get the care you need from local doctors, hospitals and other healthcare professionals.

To help ensure that you can find the care you need, we consider the following:

  • How far you have to travel to see a provider
  • The number of available providers in your area
  • The number of primary care physicians in your area accepting new patients
  • The languages the providers speak
  • How long it takes to make an appointment and see a provider
  • How easily you can access routine, urgent and emergency care

Types of providers

To best meet your healthcare needs, our networks include a wide range of health care providers. They include:

  • Primary care physicians
  • Specialists
  • Hospitals
  • Skilled nursing facilities
  • Behavioral health providers
  • Laboratories