What is open access?
Open access is a type of health insurance plan that allows policyholders to see other medical professionals in the plan’s network without first having to obtain a referral from a gatekeeper such as a primary care physician.
Health insurance plans require policyholders to follow certain rules in order to obtain care, or to obtain care at the lowest possible price. An open access plan is also known as an open panel plan. Some health insurance plans require patients to get a referral from their primary physician before seeing a specialist, such as a cardiologist. Open access plans don’t have that requirement.
But policyholders still must select a specialist provider that is in the plan’s network. Should individuals seek care from an out-of-network provider, the individual will have to pay more or be responsible for the entire bill.
Open access example
Susie and her family have an open access health plan. Susie’s daughter’s physician recommends the young girl see a specialist about a potential problem with her heart. Susie checks the list of pediatric cardiologists who are in her health plan’s network and chooses one. Her policy will cover 80 percent of the cost for an in-network specialist. If Susie had gone out of network, her share of the cost would have been significantly more.