Paul Sanchez
When doctors change locations, it can affect insurance coverage for patients. Physician turnover is not uncommon, and patients may receive a letter informing them of an upcoming change, or they may only realize this when they receive a bill that is higher than their normal copay or insurance rate. Patients can check their insurance plan's provider list to see if their doctor is still in-network, and if not, they may be able to use a transition of care to continue seeing their doctor for a limited time. Alternatively, patients may need to switch to a new doctor who is in-network or pay out-of-pocket to continue seeing their current doctor.
| Characteristics | Values |
|---|---|
| Doctor leaves provider network | Patients may be warned in advance, but out-of-network fees are often too steep to pay out of pocket |
| Doctor moves location or workplace | Patients moving out of the area may need to change insurance plans or pay out of pocket |
| Doctor changes jobs or employers | Patients may need to switch doctors or pay out of pocket |
| Doctor retires or leaves the practice | Patients may need to find a new doctor |
| Doctor no longer accepts insurance | Patients may pay significantly more |
| Doctor is out-of-network | Patients may pay more, but some insurers allow treatment with out-of-network doctors at the same level of co-pays as in-network doctors |
| Transition of care | Allows patients to temporarily see their current doctor, with time restrictions that depend on the insurer |
| Insurer requirements | Vary depending on the company and condition, e.g. UnitedHealthcare allows coverage for pregnancy up to birth and post-natal care |
| Open Enrollment Period | Opportunity to update health insurance plan outside of life-changing events |
| Special Enrollment Period | Opportunity to update health insurance plan after experiencing a qualifying life-changing event |
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What You'll Learn
Doctor leaves insurance network
It can be disappointing to learn that your doctor is no longer in-network, meaning your insurance company may no longer cover your visits, or you may have to pay a larger portion of the bill. This can happen when doctors change their location or workplace, or when insurance networks and health systems part ways. While your doctor and insurance provider are not legally obligated to inform you of these changes, you will often be warned ahead of time.
If your doctor leaves your insurance network, you may be able to retain in-network-level coverage for your doctor, at least temporarily. This is known as continuity of care protection, and it enables you to retain the same level of care from your doctor for the same copays and fees. Continuity of care protections vary depending on where you live, but they are most commonly allowed for maternity care for a high-risk pregnancy and ongoing cancer care.
If you are covered by private health insurance, you can check with both the plan and the doctor's office to see if your physician is in a new plan you are considering. You can also use a transition of care, which allows you to temporarily see your current doctor for a limited time, usually from a few weeks to several months. During this time, you can pay the same copays as you would for an in-network doctor.
If you are a senior enrolled in a Medicare Advantage plan, you may be able to leave your healthcare network if your doctor does. You can also switch plans during the Medicare Advantage Open Enrollment Period, which runs from January 1 through March 31 each year, or during the Annual Open Enrollment period, which runs from October 15 to December 7.
If you are unable to switch plans, you may be able to negotiate a reasonable cash price with your doctor, as they won't have to bill your insurance, which would save them time and administrative costs.
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Transition of care
Transitioning to a new doctor can be challenging, but there are ways to ensure continuity of care. Here are some steps to help with the transition process:
Review Your Insurance Plan:
Firstly, understand your insurance plan and its provider network. Check if your current doctor is in-network with your new insurance. Many insurance companies have websites that allow you to search for providers, or you can call your doctor's office to inquire about their accepted insurance plans.
Understand Transition of Care:
Take Necessary Steps:
To utilize transition of care, you may need to submit a "transition of care request" signed by your doctor before the plan change. This request should be made as soon as possible to ensure approval. Additionally, your new insurer may require you to fill out an application for transition of care, which they will review to determine if you can continue with your current doctor.
Seek Referrals:
If transitioning to a new doctor is inevitable, seek referrals from your current provider. They may know other physicians who participate in your new insurance plan. You can also check with foundations or national associations affiliated with specific chronic conditions to find specialists.
Choose a New Provider:
Start by determining your specific needs and preparing any questions you have for potential new providers. Contact their offices to see if they are accepting new patients, check their fees and insurance acceptance, and inquire about their in-network labs. Once you've found a suitable new provider, consider advising your current provider of your intention to switch, which can help maintain a good relationship.
Ensure Smooth Transition:
To ensure a smooth transition, request copies of your medical records and notes from your current provider and have them delivered to your new provider. Also, ensure you have enough medication to tide you over during the transition, and maintain adherence to your treatment plan by keeping appointments and lab tests.
Remember, each insurer has its own requirements for transition of care, so be sure to review the specifics of your insurance plan and take the necessary steps to maintain continuity of care.
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Out-of-network doctors' fees
When a doctor leaves a health plan, it's often because they're changing jobs or employers, or because a practice chooses not to accept the plan anymore. This can be disappointing for patients, especially when long-held doctor-patient relationships are disrupted.
If your doctor is no longer in-network, your health insurance company may no longer cover your visits, or you may find that they cover much less of the bill. Out-of-network doctors' fees are often too steep to pay out of pocket. In some cases, your new insurance company may let you receive treatment with your out-of-network doctor at the same level of co-pays as an in-network doctor. However, there are usually time restrictions on how long you can use your current doctor, and you'll have to switch doctors eventually.
To avoid unexpected medical bills, it's important to know how your plan works. Most health plans provide access to a network of doctors, facilities, and pharmacies that have agreed to accept a discounted rate for covered services. These healthcare providers are considered in-network. If a doctor or facility has no contract with your health plan, they're considered out-of-network and can charge you full price, which is usually much higher than the in-network discounted rate.
For example, an $825 charge from a doctor's visit may cost you $140 with an in-network doctor. With an out-of-network doctor, the same visit may cost $645, meaning you pay an extra $505. Out-of-network doctors can charge any amount they want because they haven't agreed to a contract price for the covered service. Not all of the extra money you pay will count toward your out-of-pocket limit. Your out-of-network deductible and coinsurance will count toward your out-of-pocket limit, but the extra amount the doctor can bill may not.
To keep your doctor when your health insurance changes, you can check the new plan's provider list to see if it includes your current doctor. Many health insurance companies have websites that let you search for providers, or you can call your doctor's office and ask if they accept your new insurance plan. A PPO plan may also allow you to see out-of-network doctors for a higher price. Additionally, a point-of-service (POS) plan might be an option, as it allows you to go out-of-network for some care.
If your current doctor is your only option, you can use transition of care, which allows you to temporarily see your current doctor in special situations where ongoing care is needed. You can contact your new insurer to find out what is covered and what you need to do to receive continued coverage.
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Preferred doctors or specialists
When it comes to preferred doctors or specialists, there are a few things to keep in mind when dealing with changes in insurance or location. Firstly, it's important to understand that doctors may enter and leave insurance networks or move to different locations, which can affect their status as in-network or out-of-network providers. This, in turn, can impact the cost of your medical care.
If your preferred doctor or specialist is no longer in your insurance network, you may end up paying significantly more for their services. In such cases, reviewing your insurance plan and considering alternative options may help lower your overall medical bills. You can check your insurance provider's website or call your doctor's office to see if they are still in-network. Additionally, some insurance plans, like a Point-of-Service (POS) plan, allow you to go out-of-network for certain care, but this may come with additional costs.
When choosing a new doctor or specialist, whether due to insurance changes or relocation, it's essential to do your research and plan. You can ask for recommendations from friends, family, or other healthcare professionals. Online searches can also be helpful, especially when using tools like the American Medical Association's doctor finder, which provides information on doctors' specialties, reputations, and malpractice records.
If you have specific medical needs, selecting a doctor with expertise in those areas is crucial. For instance, if you have children, choosing a pediatrician as their primary care physician ensures they receive specialized care. Additionally, considering factors like office location, hours, and affiliated hospitals can make your choice more convenient and suitable for your needs.
In some cases, you may be able to continue seeing your current out-of-network doctor for a transition period, especially if you require ongoing care. This option usually comes with time restrictions and may involve paying the same co-pays as in-network doctors. However, it can provide a temporary solution while you search for a new in-network doctor or specialist.
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In-network doctors
Doctors may enter and leave insurance networks, and this can be due to a variety of reasons, including moving location, changing jobs, or an insurance company deciding not to renew a contract with a particular doctor. When a doctor leaves an insurance network, patients are usually informed, either by mail or by receiving a bill that is much higher than their normal copay.
If your doctor is no longer in-network, you may be able to continue seeing them for a short period through a transition of care agreement. This allows you to temporarily continue seeing your current doctor at the same level of co-pays as an in-network doctor. However, there are time restrictions, and you will eventually need to switch doctors.
To find out if your doctor is in-network, you can check your insurance company's website, which should have a list of in-network providers. You can also call your doctor's office and ask if they accept your insurance plan, or check your plan documents. If you are choosing a new insurance plan, it is important to make sure your preferred doctors are covered.
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Frequently asked questions
When your doctor leaves your health plan network, your health insurance company may no longer cover your visits, or you may have to pay more for them. You can check if your doctor is still in-network by reviewing the new plan's provider list or calling your doctor's office.
If your doctor is no longer in-network, you may be able to continue seeing them for a short period of time using transition of care. This allows you to see your out-of-network doctor at the same level of co-pays as an in-network doctor for a limited time. Alternatively, you may be able to switch to a different insurance policy that covers your doctor during the Open Enrollment Period or a Special Enrollment Period after certain life events.
If your doctor changes location but remains in-network for your insurance plan, you can continue seeing them at their new location. You may need to inform your doctor's office of your insurance plan if it has changed since your last visit.
If your insurance plan changes, your current doctor may still be in-network. You can check by reviewing the new plan's provider list or contacting your doctor's office. If your doctor is no longer in-network, you may have to switch doctors or pay more to continue seeing them.
