One of the ways that health care coverage plans are able to offer reasonable rates to their members is by limiting the amount of physicians that they can see. Any managed plan – be it an HMO, PPO, or even self-directed health organization – will have a list of providers which the patient can use. While it is sometimes possible to go outside of this network of providers, it can be extremely expensive as no part of the bill will be covered by the organization. As well, many providers will not see patients from other HMOs as they are already booked full with their own network’s appointments, or have been prohibited from doing so by the provider.

As health care plans become more accessible, some companies have recognized the need for greater patient choice when it comes to physician care, especially in the event that a specialist is needed. Even among network providers, many health care coverage plans required patients to first obtain a referral from the general practitioner, as well as permission from the plan administration itself before a visit to the specialist could be booked. This led to not only substantial amounts of bureaucratic red tape, but a great deal of resentment on the part of many patients who felt that the management of their care was out of their hands.

Fortunately, many plans are now implementing what are known as open access policies, which allow patients to book appointments with doctors and specialists from within the network without the need for a referral or express permission from the company. This allows patients greater and more streamlined access to care, as they can make an appointment immediately, rather than waiting for permission or setting one up and having to cancel because their approval did not come through. This system of open access policies is also known as open panel in reference to the panel of physicians which make up the entire network. While there are still very few plans that let patients go outside the network, some will pay a minimal amount of an outside-network doctor’s cost, and there are some independent physicians or those in open PPOs who will see patients from other plans.

While the open access policies employed by newer managed care organizations (MCOs) are not perfect, they do help to increase the ability of patients to get care where and when they need it. This can be extremely important for patients who have a disease such as cancer, which can act quickly upon a body but can also be very effectively treated provided it is caught early. Greater access to doctors and specialists means healthier patients and ultimately less pay outs by insurance companies.