By Nathan Blake |1/17/17
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 longtime doctor, she wasn’t prepared to hear bad news: Ruth’s doctor doesn’t accept her new employer’s health plan.
Now she faces a unpleasant decision. Either look for new health insurance outside her employer’s plan, or start from scratch by finding another primary care physician.
Losing access to a doctor you trust isn’t just demoralizing. It’s also incredibly time-consuming. Finding a good “fit” often requires trial-and-error and a fair bit of luck. But the effort pays off in the long run. 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 doesn’t work with your new insurer.
What happens when a strong doctor-patient relationship is suddenly jeopardized because of health insurance compatibility?
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. Totally understandable. The first step you should take is an easy one: Ask your doctor what insurance carriers they DO accept.
Rather than searching for 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 work with out-of-network coverage. 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, always ask for specific reasons. You can also present the doctor with reasons why they should join a particular network. Sometimes a vocal patient is enough to do the trick. It can’t hurt to ask!
• Negotiate a discounted price with your doctor. More and more medical providers are choosing not to take on contracts with insurers in today’s tumultuous insurance market. The result is that patients insured through incompatible plans are forced to pay the market price for medical services up-front. However, some doctors are willing to 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. 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. Always keep in touch with your insurer during the reimbursement process and make sure your voice is heard.
When It’s Time to Move On
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. Or, you can search our collection of physician websites by browsing the “Physicians” tab on our homepage.
Being prepared for change and informing yourself of available options is your best bet for making a smooth transition between providers. Comment below and let us know if we helped!