When Your Doctor Doesn’t Accept Your Health Insurance Plan

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!

17 thoughts on “When Your Doctor Doesn’t Accept Your Health Insurance Plan”

  1. Bruce Hueg says:

    Doctors and insurance companies care more about money than health!!!!!

    1. Bruce Hueg is absolutely correct in his statement and reflects my opinion exactly.

    2. Last time I checked a doctors education wasn’t free nor was the rent, electrical bills malpractice etc etc. I don’t know many mechanics that care more about cars than getting paid or for that matter plumbers electricians etc etc. you sound like the perfect government unionized retired and possibly welfared American

      1. Peggy Quinn says:

        Sue – unfortunately that is not always the case. With marketplace crappy insurance most doctors aren’t contracted with my insurance company. Was told self pay is fraud and won’t accept. BS. I don’t want free nor do I want a discount. I want the doctor. I’ve seen him before. If my insurance isn’t accepted; and not looking for cash discount; why can’t I just pay myself??? Not trying to bypass insurance company, can’t use it.

  2. Connie lanette says:

    My doctor does not accept my insurance so I was going to pay cash for my
    Visits but she is saying it is illegal for her to do that.Is it illegal for a dr to take cash when they don’t accept someone’s insurance?

    1. HealthWeb Navigator says:

      Hi Connie,

      Sorry to hear about your problems. We don’t know the legality of your situation, so we would advise you call your insurer to find out about the specifics. They will have the answer you’re looking for. Let us know how it goes!

      1. R. Branca says:

        A rehab facility I need to go to for specialized care just told me the same thing. They claimed its Massachusetts state law, and explained that it’s supposed to prevent providers from “double dipping”. I can’t understand why they are allowed to refuse your insurance when they know they also aren’t allowed to let me self-pay.

    2. Debbie C. says:

      I pay cash for my OB/GYN. There is no law that says you can’t.

      1. Peggy Quinn says:

        So do I here in Illinois since doc not contracted with insurance. Also, major hospital in Chicago does same thing- takes check since not contracted with insurance.

        1. HealthWeb Navigator says:

          Billing for medical care is very complex these days. It’s not uncommon for providers to be unaware of the billing policies, especially since most are not involved in their creation. Also, it’s not always the doctor’s choice about what insurances to take, sometimes it the other way around.

          As before, I suggest starting by talking directly to your provider.

  3. This article didn’t help much with my problem (turned 26, kicked off my parents plan, in between jobs so I got medicare and my PCP told me they couldnt even refill my prescriptions because they dont accept medicare) but it just drove home the fact that medical insurance and doctors are scams. Seems they were more upset I had to cancel my “medication check” because I couldnt afford it then actually helping me. Im a lawyer and it doesnt make any shred of sense that a dr cant write me a prescription because of the type of insurance I carry – if I had no insurance I could get a prescription but even if I pay out of pocket for the visit all I can get is someone to talk to about my symptoms? WTF

    1. Just tell your doctor you need a prescription on paper. He doesn’t need to know whether or not you are insured. If you are at the dr’s for a visit whether self pay or using insurance get a written prescription then take it to CostCo or use GoodRx and have it filled. Sometimes using CostCo or GoodRx is cheaper than using insurance to have it filled. https://www.goodrx.com/how-goodrx-works Did you know that if you need any procedure I.e. MRI that the facility can only charge you what Medicare would pay for the procedure? My insurance co denied me getting an MRI. I contacted the facility myself and instead of charging me $1600 they could only charge me $240 for the MRI on a self pay basis. And I did not have to share the MRI results with the insurance company.

      1. HealthWeb Navigator says:

        For many people using less expensive pharmacies is good advice, but many people would still find it difficult to pay for drugs. The recommendation to talk to your doctor may result in a number of measures. The doctor may be able to prescribe a less expensive drug, give you samples, or refer you to patient assistance programs, such as those listed on our site NeedyMeds.

  4. R. Branca says:

    I had to stop reading after the first solution offered was “switch health plans” followed by irrelevant advice about how marketplace changes can only be made during certain times of the year.
    anyone with access to employer-provided health plans are REQUIRED to use it, and do not qaulify for marketplace plans.
    what I had hoped to find was: what if your insurer is willing to work with out-of-network providers, but your provider refuses to work with them AND refuses to just let you self-pay and submit your own claims?
    It’s a brand new wrench for me in our exhausting, Brigadoon style healtcare system, and unfortunately I won’t be able to trust a site that displays such basic ignorance (or is it callousness?) about the most vexing barrier: employers in charge of healthcare while decrying the cost of that responsibility.

  5. Bradley Cotton says:

    This seems to be a great discussion. My son’s psychiatrist does not take insurance and so, I am forced to submit for reimbursement at only 70%. The problem now is complicated: changed jobs, lower pay, rising credit card debt, etc. Good news/bad news. My new company covers in-network psychiatry for only $20 per visit! Bad news is my son’s psychiatrist is STILL not taking insurance.

    How can I get my son’s psychiatrist to join the CIGNA network? I understand that my son’s Dr would only get a some portion of his now raised rate – maybe 75%? 65%? – What are the rates that psychiatrists get from insurance networks? ANY details would be great hear about… thanks!

    1. HealthWeb Navigator says:

      Hi Bradley,
      Most rates are arrived at by negotion between the insurance company and healthcare provider or their network. It is impossible to speculate on the specific details of each situation. Although most healthcare providers accept insurance, since most patients have it, they are free to choose which ones they accept, or none at all if they want to get paid their full fee. Only your son’s psychiatrist can answer your questions, so you need to speak with them.

  6. I liked that you said that one thing to look for when finding a doctor is to make sure that they accept your health insurance. I have been thinking about finding a new doctor that will take my health insurance so that I can better afford their services. I will make sure to find a medical professional that takes my insurance so that I can make sure to receive the proper healthcare.

Leave a Reply

Your email address will not be published. Required fields are marked *

Subscribe to our blog

Name *
Email *