Your doctor left your plan's network. Now what?
Four options, in the order worth trying — and the continuity-of-care rule most people have never heard of.
By Desmond Okoye, Cedar Landing Benefits
A letter arrives saying your physician will be out of network from a given date. It feels like an emergency. Usually it is not, but it does have a clock on it.
Work through these in order.
First, confirm it is true
Network directories are frequently out of date in both directions, and contract disputes are often settled before the deadline. Call the practice, not the insurer, and ask whether they expect to be in network next month.
A surprising number of these letters are resolved before they take effect.
Then ask about continuity of care
If you are in active treatment — pregnancy, chemotherapy, a scheduled surgery, a serious ongoing condition — many plans must allow a transition period at in-network rates. It is not automatic. You request it, usually in writing, and the plan applies its rules.
That request is the most valuable thing in this article, and almost nobody makes it.
Then consider whether to move
If you have an Advantage or Part D plan and your doctor's departure makes it unworkable, the Annual Enrolment Period from 15 October is the usual route to change. Certain circumstances open a special enrolment period sooner.
And sometimes the honest answer is to stay and pay out of network for a specific relationship worth keeping. That is a legitimate choice as long as it is made deliberately.
An estimate for planning, not a quote. Medicare and the Marketplace set your real figures.
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