How to Find a Doctor If Yours Has Left Your Health Plan

Going to the doctor usually doesn’t allow for casual small talk, as you may only see them once a year. Often, you must explain your ailment quickly and succinctly. You also have to trust that your doctor has your best interests at heart and keeps your health information confidential. Having a good relationship with your doctor can help alleviate these issues and even increase the quality of your health care.

But what if you finally have a good relationship with a doctor you like and then learn that they are no longer in your health insurance network?

Why Doctors Leave Health Insurance Networks

Usually, doctors leave health insurance networks for typical reasons, such as retirement or if they move geographic locations. They are professionals, after all, and just as you probably have had to move for a new job, they do the same. Sometimes, their reasons may be somewhat more technical. For example, a doctor may be unhappy with how the health insurance network conducts business.

You’ll most likely receive some warning ahead of time if your doctor is leaving your network, so that you have time to plan. However, neither your doctor nor your health insurance provider is legally obligated to inform you if your doctor is no longer in your network.

Unfortunately, this can then lead to an unexpected increase in medical bills, a situation that is all too common and can leave you financially crippled for years. This is why it is so important to call your doctor’s office during open enrollment each year and verify they will still accept your insurance plan.

What to Do If Your Doctor Leaves

If your doctor leaves your network, you may have continuity of care protection. This can enable you to retain the same level of care from your doctor for the same copays and fees temporarily.

If you are a senior who participates in a Medicare Advantage plan, you have the option to leave your health care network if:

• your doctor does; and
• if the network change is, according to the Centers for Medicare and Medicaid Services guidebook, “considered significant based on the [effect] or potential to affect current plan enrollees.”

If you currently have coverage under a private plan and are considering switching, call your doctor’s office and ensure they are covered under the new plan you are considering.

Not everyone can switch health insurance plans. If that's the case, keep in mind that doctors will often allow you to pay cash for your visits. You may be able to negotiate a reasonable cash price with your doctor because they won’t have to bill your insurance, which would save them time and administrative costs. If your doctor’s cash price is relatively high, it may still be worth it to maintain continuity of care.

Other Options

If the previous options are out of the question for you, the next best thing to do is to ask your doctor if they can provide any referrals. After all, your doctor will know your situation best and can refer someone else who will be a good fit for you.

Having a doctor you like and trust can be such a relief, and it’s always an unfortunate circumstance when your health insurance network no longer covers that doctor. Fortunately, there are ways you can plan for this and methods to make a smooth transition to a new physician. If you need assistance in this process or have questions about anything you have read, contact an elder law attorney.

Elder law attorneys can direct you to helpful information and resources. They are dedicated to helping families with senior loved ones who may be experiencing declining health. They also can provide professional guidance on long-term care options when you (or a loved one) are facing a transition to in-home, assisted living, or nursing home care.