Key Takeaways

• A provider’s name appearing in a PSHB plan’s directory does not guarantee they are actively participating in the network—verification is essential before you seek care.

• Relying on assumptions or outdated listings may result in unexpected out-of-network charges, denied claims, or disrupted treatment continuity.

What the PSHB Transition Means for Your Provider Network

As of January 1, 2025, the Postal Service Health Benefits (PSHB) program officially replaced the Federal Employees Health Benefits (FEHB) Program for all USPS employees, annuitants, and eligible family members. With this transition comes a reshuffling of provider networks that can catch you off guard if you aren’t paying attention.

You may assume that because you stayed with the same insurance carrier or plan name, your doctors and hospitals are still covered—but that is not always the case. PSHB plans often use different networks or negotiate separate contracts. A provider listed previously under FEHB might not appear in your PSHB network, or they may no longer accept your plan due to contract changes.

Why Network Listings Are Not Always Reliable

While PSHB plans do provide online directories, they come with limitations. Here’s what you need to keep in mind:

• Lag Time in Updates: Providers may have opted out recently, but the plan’s website hasn’t reflected the change yet.

• Multiple Plan Networks: A provider could participate in one PSHB plan network but not in another—even from the same insurance group.

• Partial Participation: Some doctors might only accept certain plan tiers, specific locations, or types of services.

In short, just seeing a name on the list isn’t enough. You have to confirm it—every time.

Steps to Take Before You Book Any Appointment

To avoid confusion or unexpected bills, take these actions before seeking care under your PSHB plan:

1. Call the Provider Directly

Ask them clearly:

• “Do you accept this specific PSHB plan, by name, for the type of service I need?”

• “Are you accepting new patients under this plan?”

• “Will this apply to all providers at your practice or just select physicians?”

Make sure to note the date and name of the person you spoke with.

2. Double-Check Through the Insurer’s Member Services

Call the plan’s member services number (found on the back of your PSHB ID card) to:

• Verify that the provider is listed as in-network.

• Confirm that no pending contract terminations are scheduled.

• Request written confirmation if possible.

3. Use the Online Provider Directory Cautiously

While online tools are helpful, treat them as a starting point—not your final check. Filter results by ZIP code, specialty, and plan type, and be wary of listings with vague location or contact details.

Watch for These Common Red Flags

Not all discrepancies are obvious. Here’s what often misleads PSHB members:

• Same Practice, Different Billing: A facility may accept your PSHB plan, but if the doctor bills separately, their services could be out-of-network.

• In-Hospital Services: An in-network hospital does not guarantee that the anesthesiologist, radiologist, or surgeon treating you is also in-network.

• Retired Provider Listings: Some directories are not purged of retired or relocated providers, leading to dead ends.

What Happens If You Use an Out-of-Network Provider

If you accidentally receive care from a provider who’s out-of-network, you could face:

• Higher Coinsurance: PSHB plans often require 40%-50% coinsurance for out-of-network services.

• Higher Deductibles: Your out-of-network deductible could be double or more compared to in-network.

• Surprise Balance Billing: The provider can bill you the difference between what they charge and what your plan pays.

• Rejected Claims: Some plans may not cover the service at all, especially if a similar in-network provider was available.

In-Network vs Out-of-Network: A Quick Comparison

Always refer to your plan brochure for exact figures—these are general examples for 2025.

Special Caution for PSHB + Medicare Enrollees

If you’re Medicare-eligible and enrolled in both Medicare Part B and a PSHB plan, your coordination of benefits becomes critical:

• Primary vs Secondary Payer: Generally, Medicare pays first, and PSHB acts as secondary. But out-of-network PSHB providers may not coordinate billing properly, leaving you with a larger balance.

• EGWP Prescription Coverage: If you opt out of your PSHB plan’s Medicare Part D coverage, your medication access and cost protections may be limited.

• Waived Cost-Sharing: Many PSHB plans reduce or eliminate cost-sharing for those with Medicare Part B—only if you use in-network providers.

What You Should Do During Open Season and Beyond

The November to December Open Season is your annual opportunity to make changes—but ongoing awareness matters too. Here’s how to stay proactive:

• Review Plan Brochures Each Year: Networks and benefits change. Don’t assume continuity.

• Check the Annual Notice of Change (ANOC): This document outlines shifts in coverage, cost-sharing, and provider availability.

• Ask Your Providers Annually: Each year, verify whether your providers still participate in your chosen PSHB plan.

• Document Everything: Keep a log of who you speak with, when, and what they say—this could help you resolve disputes later.

If Your Provider Leaves the Network Mid-Year

It’s frustrating, but it happens. Here’s how to respond:

• Contact Your Plan Immediately: Ask about continuity-of-care protections—some plans will honor in-network cost-sharing for a limited time.

• Request a Referral: Your primary care provider can often refer you to a similar in-network specialist.

• File an Appeal If Needed: If you’ve been misled by incorrect listings or are in the middle of treatment, you may qualify for an exception or appeal.

Don’t Rely on Assumptions—Rely on Verification

When it comes to health coverage, being proactive pays off. Verifying your providers’ participation in your PSHB plan isn’t just a best practice—it’s essential for protecting your wallet and your health. Even a simple phone call or double-check through your plan’s member services can prevent significant frustration later.

Whether you’re already using a PSHB plan or just preparing for your next Open Season selection, take the time now to confirm who’s really in your network.

Get Help Navigating Your PSHB Network

The provider network behind your PSHB plan isn’t always what it seems. To make informed choices, take time to verify all details—not just once, but regularly. Avoid relying solely on plan directories and always confirm with both the provider and your plan. If your provider turns out to be out-of-network, the costs and confusion can escalate quickly.

For help understanding your PSHB options, provider listings, or how to confirm network participation, reach out to a licensed agent listed on this website. They can guide you through the process so you’re not caught off guard.