By Nathan Blake | 1/17/17
Updated | 7/5/18
Ruth finally made a career change and is loving all the extra free time she has to spend with her granddaughter. But when she called to schedule an annual physical with her primary care doctor, she didn’t expect to hear bad news:
Ruth’s doctor doesn’t accept her new employer’s health insurance plan.
Now she has to make some hard decisions. Either look for new health insurance outside her employer’s plan, or start from scratch by finding another primary care physician.
Losing Your Doctor Unexpectedly
Losing access to a doctor you trust isn’t just disappointing. Eventually you have to find a new doctor, and that doesn’t happen overnight. Finding a good fit takes planning, trial-and-error, and a good amount of luck.
But don’t let that stop you from trying. Research shows that the more satisfied a patient is with their healthcare provider, the better the odds they will experience a successful treatment.
Like Ruth, you may have changed jobs and are on a different health plan. Or you may have had to find another health insurance policy with lower co-pays just so you could afford the costs of your prescription medications. In either case, it’s possible that your medical provider won’t accept your new policy.
Below are some strategies for what you can do if you want to keep seeing your doctor despite insurance incompatibility.
When You Just Can’t Stand to See Your Doctor Go
So your preferred doctor doesn’t accept your new health insurance, and you don’t want to find another provider. The first step you should take is an easy one: Ask your doctor what insurance carriers they DO accept.
Rather than finding a new doctor, you can switch to a different health insurance policy that you know your doctor will work with.
Unfortunately, Marketplace plans can only be changed during certain times of the year or for specific “special enrollment” scenarios like having a baby, getting married, losing a job, etc.
Check online to see if you qualify for special enrollment before you make any big decisions. If Ruth is eligible for special enrollment, this is by far the most painless solution.
But there are other options if you can’t afford the cost or hassle involved with switching policies. If you desperately want to keep your doctor, you can:
• See if your plan will cover out-of-network costs. If your doctor isn’t in your insurer’s network, call the insurer directly to see if they would consider adding your doctor to their network of providers. If they refuse, ask for specific reasons why. You can also try to convince your doctor to join a particular network. Sometimes a vocal patient is enough to do the trick. It may not work, but it can’t hurt to ask!
• Negotiate a discounted price with your doctor. It’s common for medical providers to limit the number of insurers they work with. The result is that patients insured through incompatible plans are forced to pay the market price for medical services up-front. But some doctors will negotiate prices with patients on an individual basis, especially if there’s already a long-standing relationship. The key to these negotiations is knowing the fair price for a given health expense and working from there. Again, it costs nothing to ask, and the potential payoff is worth it.
• Visit an urgent care center or walk-in facility. Urgent care centers and walk-in clinics are set up to treat patients with non-life-threatening illnesses and injuries like fevers or the flu, bleeding/cuts, sprains/strains, etc. They’re also good for immunizations and some diagnostic services such as X-rays and routine lab work. What’s great about these centers is that they are relatively inexpensive, require no appointments, and are generally open seven days a week. If you can save money on “small” issues, then you may be able to afford seeing your doctor for the more serious issues that crop up from time to time.
• Pay the difference out-of-pocket and seek reimbursement later. This one hurts. But if you have the financial resources to do so — and if you absolutely MUST keep your doctor — then you can pay for their services out of pocket and then submit insurance forms for reimbursement. It’s important to note that insurers will often apply reimbursements to your policy deductible (how much you’re expected to pay before the insurer picks up the bill) rather than give you the money outright. There’s also a good chance you will be reimbursed for only a portion of the original cost. Stay in touch with your insurer during the reimbursement process and make sure your voice is heard.
When It’s Time to Move On
Sometimes the cards just don’t play out the way you want them to. If you can’t afford to see your doctor without health insurance, and none of the above options works for you, then it might be easier to simply move on and find another doctor in your new network. Most health plans these days provide a list of physicians in their network. Call your plan directly for more information.
For tips on how to find the right doctor, we have an entire post dedicated to choosing a primary care physician.
You can search our collection of websites for finding a doctor in the Doctors & Hospitals category.
Being prepared for change and knowing what options are available is your best bet for making a smooth transition between providers. Comment below and let us know if we helped!