Meeting with your doctor is more than just a quick visit with someone you may see only once a year. If you have an ailment, you must explain it quickly and clearly, trusting that your doctor will give you their best advice and keep your health information confidential. This is uncomfortable for many people since health issues are highly personal.
Establishing a good relationship with your doctor may take time, but it can alleviate anxiety and can even increase the quality of your healthcare. So, if your doctor leaves your health insurance network, it can create a stressful situation for you.
Why Doctors Leave Health Insurance Networks
Doctors leave health insurance networks for various reasons, including retiring or moving away. Sometimes, however, a doctor is unhappy with how the health insurance provider conducts business.
If your doctor is leaving your health insurance network, you may be notified ahead of time. However, neither your doctor nor your health insurance provider are legally obligated to inform you if your doctor has left your network.
If your visits to your doctor are no longer covered by your insurance, you may end up with big medical bills that could take years to pay off. For this reason, it is important to call your doctor’s office and ensure your doctor is still covered under your plan when you reach your open enrollment period each year.
What to Do if Your Doctor Leaves Your Network
What should you do if your doctor leaves your network? First, you should find out if you have continuity of care protection. If you do, you might be able to temporarily continue the same level of care with your doctor for the same fees and copays.
According to the Centers for Medicare and Medicaid Services, if you are enrolled in a Medicare Advantage plan, and your doctor leaves your health care network, you may have the option to leave the network and continue your care. The network change has to be considered significant based on the effect, or potential effects, it will have on current plan enrollees.
If you have health insurance with a private plan and are considering changing to a different private plan, you should first make sure your doctor is covered under the new plan you are considering.
If you can’t switch plans, find out if your doctor will allow you to pay cash for your visits. You might be able to negotiate a reasonable rate if you pay in cash. Some doctors offer a discount to patients who pay in cash because they don’t have to deal with an insurance company, which saves them time and money. Even if your doctor’s cash rate is expensive, it may be worth it so that you can continue your care with your doctor.
If you are unable to continue care with your doctor, you can ask your doctor if they can refer you to another doctor. Since your doctor knows your health and the level of care you need, they may be able to recommend another doctor who can offer you the same level of care.
If you need assistance in this process or have questions regarding health insurance, including Medicare, please contact our office. Our elder law attorneys and staff are here to help you. we can be reached at (207)848-5600 or check out CONTACT.