**Informed Insurance: New Doctor, New Plan**

Changes in your health insurance coverage can be frustrating, especially when it comes to choosing a doctor. Most insurance plans have a list of in-network providers with whom they have contracts, and while you can visit out-of-network doctors, their fees are often too steep to pay out of pocket. However, there are a few things you can do to inform your insurance company of a change in doctors and ensure you receive the care you need.

Check if your doctor is in-network with your new insurance

When you change your insurance, it's important to check if your doctor is in-network with your new provider. This is because doctors who are in-network have agreed to accept payment from your insurance company at a set price, which keeps costs low for you.

• Check your insurance company's website – Most insurance companies have a provider directory on their website, which allows customers to find doctors that are in-network for their plans. If you're a HealthPartners member, for example, you can search your network through your online account or mobile app.
• Call your insurance company – Reach out to your plan's member services team to get help with any questions about your plan. You can usually find their phone number on your health insurance member ID card.
• Ask your doctor's office – Your doctor may be able to tell you if they take your insurance plan by looking at your health insurance card. However, it's always best to confirm with your insurance plan.
• Check often – Insurance companies routinely review and amend their networks, so it's a good idea to make sure your doctor is in-network before scheduling an appointment or switching plans.
• Use an in-network provider for preventive care services – It's especially important to see an in-network doctor for preventive care services, as these are usually covered 100%, but only when you receive care from a doctor or clinic in your network.
• Use an online price transparency tool – Most insurance carriers have price transparency tools that can help you estimate what you'll pay out of pocket, both for in- and out-of-network care.
• Call your doctor's office and ask for their tax identification number – Then, call your insurance company's general line and give them the name of your plan and your doctor's tax ID number. They will be able to confirm whether or not your doctor is in-network.

Remember, if you see an out-of-network doctor, you will likely have to pay higher out-of-pocket costs. Therefore, it's important to check and confirm that your doctor is in-network with your new insurance.

Ask your doctor's office if they accept your new insurance

When it comes to changing your insurance, it's important to ask your doctor's office if they accept your new insurance plan. This is because doctors can be either in-network or out-of-network, which affects how much you'll have to pay for their services.

Most insurances have what are called "in-network" providers. These providers have contracts with insurance health plans, and while you're able to visit out-of-network doctors, they may charge higher out-of-pocket fees.

If your doctor is in-network, you can continue seeing them without having to worry about higher costs. However, if they are out-of-network, you may have to consider switching doctors or paying the higher fees.

To find out if your doctor is in-network, you can take the following steps:

• Check your health insurance plan's provider directory: Visit your health plan's website and review the list of doctors, hospitals, and other healthcare providers that your plan contracts with.
• Contact your insurance company: Give them a call or visit their website to see if they have a list of in-network providers.
• Call your doctor's office: Ask them directly if they accept your new insurance plan. Most receptionists and office professionals will know whether they are in-network or not.

It's important to note that even if your doctor is out-of-network, you may still be able to negotiate a cash price or a flexible payment plan with them. Additionally, if you are in the middle of treatment for a serious condition, your new insurance company may allow you to continue seeing your current doctor, even if they are out-of-network.

If your doctor is out-of-network, you may be able to negotiate a cash price

• Do your research: Find out the average cost of the procedure or visit in your area. Websites like Healthcare Bluebook, Fair Health Consumer, and New Choice Health can help you understand the typical cost.
• Ask for a discount: Don't be afraid to ask your doctor if they offer any discounts for paying in cash. Many doctors are willing to work with their patients to find a suitable payment plan.
• Offer to pay upfront: Doctors may be more inclined to offer a discount if they are guaranteed payment upfront. If you can afford to pay in full at the time of your visit, do so. This benefits both you and your doctor.
• Consider a healthcare savings account: If you have a high-deductible plan, a healthcare savings account (HSA) can help you save money on medical expenses. With an HSA, you can use the funds to pay for medical expenses tax-free, and any unused funds roll over to the next year.
• Shop around: Prices can vary between doctors and facilities, so don't be afraid to compare prices. You may be surprised at how much you can save by going to a different doctor or facility.
• Get an itemized bill: Ask your doctor for a line-by-line breakdown of all medical costs. This will show you exactly what each fee is for and give you a better sense of what charges, if any, could be reduced or removed.
• Start the money conversation early: Unless you require an emergency procedure, talk to your doctor's financial staff as early as possible to give yourself time to negotiate.
• Get a second opinion: It's common for patients to seek a second opinion. If your doctor is suggesting a procedure, ask why and whether it's necessary. If you're not convinced, ask another doctor for their opinion and a second quote. You might find that one doctor charges much more than another for the same service.
• Be polite and professional: Doctors and their staff are often under a lot of stress. Remain calm, collected, and respectful when discussing financial matters.
• Be prepared to negotiate: When contacting your healthcare provider, be ready to negotiate. Explain your situation and ask if they offer any discounts for cash payments.
• Ask about financial assistance programs: Some hospitals offer discounts if you meet certain income requirements. Additionally, federal requirements mandate that nonprofit hospitals provide financial assistance programs for low-income patients.

If you are receiving treatment for a serious condition, your new insurance company may work with your current doctor

The transition of care period will vary depending on your insurer, but it can last anywhere from a few weeks to several months. During this time, your new insurance company should treat your medical bills as if you received in-network care. It's important to note that there are usually strict rules around how this process works, and you will likely need to submit a "transition of care request" signed by your doctor before the plan change is made.

To increase your chances of approval, it may be helpful to ask your doctor to advocate for you and explain to the insurance company why it is important for you to stay under their care. They may be able to provide a compelling argument or clinical notes to support your case.

Additionally, it is worth noting that some insurance companies are taking a different approach by opening their own doctors' offices and clinics. This strategy aims to reduce costly diseases and hospital stays by providing primary care for patients. However, it is essential to be cautious and ensure that cost-cutting does not compromise the quality of care provided.

If you are receiving treatment, you may be able to apply for a transition of care or continuity of care

To apply for the transition of care, you must submit a signed "transition of care request" from your doctor before the plan change is made. This request must be submitted as soon as possible, as the approval process can take time, and treatments must be approved by the insurance company before they are rendered. Situations that may qualify for transition of care include chemotherapy, radiation, surgeries performed in stages, post-surgical care, organ or bone marrow transplants, and high-risk pregnancies.

Continuity of care is a protection that allows you to be treated at in-network coverage levels for specific medical and behavioural conditions, even if your healthcare provider leaves your plan's network. This protection is mandated by the surprise medical billing legislation passed in December 2020. For plan years starting on or after January 1, 2022, a group health plan must provide transitional care for up to 90 days for individuals undergoing a course of treatment for a serious and complex condition, undergoing institutional or inpatient care, scheduled for non-elective surgery, pregnant and undergoing treatment for pregnancy, or terminally ill and receiving treatment.

Frequently asked questions