By Nathan Blake | 1/17/17
Updated | 9/14/18
When I relocated from Massachusetts to Virginia, I was lucky to find a doctor I really liked. She was smart, sympathetic, had a sense of humor, and treated me like a person instead of a checklist.
But a few weeks following one of my routine checkups, I was shocked to find that the clinic had charged me nearly 3 times more than what they usually did for such a visit.
I called my insurer thinking there must have been some kind of billing error. Come to find out, that surprise bill was the result of a recent restructuring of my insurance plan. My doctor no longer worked with my employer-based health insurance and was now considered “out-of-network.” If I wanted to continue being her patient, I would have to pay the full cost for every visit out of my own pocket.
Health insurance is about as easy to grasp as quantum physics. Deductibles, out-of-pocket maximums, copayments, in-network coverage, co-insurance, accumulation periods — few people know how their health plan works, especially since plans change over time. But not knowing what your health insurance policy does — and doesn’t — cover can leave you exposed to unexpected medical costs down the road.
What do you do when your doctor doesn’t accept your health insurance? Keep reading for a few tips that might just keep you under your preferred doctor’s care no matter what your health insurance situation is.
What to Do When Your Doctor Doesn’t Accept Your Insurance
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 you’re 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:
• Ask your insurer to add an out-of-network doctor to their network. If your doctor isn’t in your insurer’s network, call the insurer directly to see if they’ll consider adding your doctor to their network of providers. If they refuse, ask for specific reasons why. You can also try convincing your doctor to join a particular insurer’s network. Sometimes just being determined is enough to do the trick. It may not work, but it can’t hurt to try!
• Negotiate a discounted “cash 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 price for medical services up-front. Thankfully 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, don’t require appointments, and are often 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 your doctor is too good to let go of — 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.
There are a lot of great websites out there to help you find the doctor of your dreams. Check out of 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 how your situation worked out!