What is meant by the term “network provider” in managed care plans?

The term “network provider” in managed care plans refers specifically to healthcare providers who are under contract with the insurance company to deliver services to members of the plan. These providers agree to certain terms and conditions set by the insurer, which typically includes accepting predetermined payment rates for services rendered. This arrangement benefits both the insurer and the members, as it creates a structured network of providers that can offer care at reduced costs for the policyholders.

By coordinating care within a network of contracted providers, managed care plans aim to control healthcare costs while ensuring that members receive quality care. This setup often includes requirements for referrals and prior authorizations to streamline care and promote efficient use of healthcare resources.