Freedom Health and Optimum HealthCare Certification Practice Exam

In plans with narrow networks, access to specialists and hospitals is restricted to those contracted with the plan through a specific network structure. This typically means the PCP’s integrated delivery structure—the PCP’s IPA or medical group—has contracts with the plan, and only providers within that contracted network are considered in-network. The PCP often acts as a gatekeeper and may require referrals to in-network specialists. This setup helps control costs and coordinate care. Providers outside the contracted IPA or medical group aren’t covered at in-network rates, or may not be covered at all.