Health insurance in the United States can feel like a maze. Once you find a doctor, you can’t be sure if you can keep on seeing them, especially if your health coverage changes.
Doctors leave provider networks, employers switch health insurance providers, and a host of other issues may lead to a change in your plan. If your health insurance changes, here’s how you can keep your doctor for as long as possible.
Check Your Health Insurance Plan’s Providers
If your health insurance plan changes, check with the new plan provider to see if your doctor is in network. Review the new plan’s provider list to see if it includes your current doctor. Many health insurance companies have websites that let you search for providers. This makes it easy to do a quick check to see if your doctor is in the network.
Another option is to call your doctor’s office and ask if they accept your new insurance plan. Most receptionists and office professionals know whether they’re in-network.
What if Your Doctor’s Not In Network?
A PPO also allows patients to see out-of-network doctors. So, you can keep your doctor when your health insurance changes — for a price. Without the in-network agreement, you’ll pay extra to do this. Run the numbers to see if you can afford to keep seeing the same doctor if they’re outside the PPO.
Additionally, a point-of-service (POS) plan might also be an option. With this plan, you choose an in-network provider, but can also go out-of-network for some care. One benefit with a POS plan is that if you receive a referral to an out-of-network provider, the health insurance will pick up the tab. If you can get an in-network provider to make the referral, you might be able to keep your doctor.
Finally, ask about cash payments. In some cases, your doctor might be willing to offer a discount if you pay in cash. If you can afford to pay out of pocket with the discount, you can keep the same doctor.
Can You Keep Your Doctor If You’re on the ACA Exchange?
The Affordable Care Act (ACA) made provisions for those who don’t have other options for health insurance. If your workplace doesn’t offer affordable health insurance coverage, or if you’re self-employed, you can turn to an ACA exchange. Many states have exchanges that offer a variety of plans to choose from. Before selecting a plan, check if your physician is in-network.
Planning ahead can help you choose a plan more likely to cover your doctor visits.
Using Transition of Care to Keep Your Doctor Temporarily
What if your current doctor is your only option? Your new health insurance doesn’t include your doctor and an out-of-network option might not be workable. In that case, you can use transition of care.
What’s Transition of Care?
Transition of care allows you to temporarily see your current doctor for special situations where ongoing care is needed. In many cases, a new insurance company lets you receive treatment with your out-of-network doctor at the same level of co-pays as an in-network doctor.
There are usually time restrictions on how long you can use your current doctor, however. At some point, you’ll have to switch doctors, but transition of care can at least help you manage the change. How long you have depends on the insurer. It can be anywhere from a few weeks to several months.
What Does Transition of Care Cover?
You need certain conditions to qualify for transition of care with your new insurance company. Each insurer has its own set of requirements. For example, UnitedHealthcare may allow you to keep your doctor when your health insurance changes in the following cases:
- Newborn care
- Cancer treatment
- Major surgery
- Terminal illness
- Substance abuse
- Behavioral health1
Each condition has different limitations. With pregnancy for United Healthcare, coverage continues up to birth followed by six weeks of post-natal care. On the other hand, behavioral health is not as clear cut, allowing for a “reasonable period of time to safely transition care to a network health care professional.”
Contact your new insurer to find out what is covered and what you need to receive this continued coverage. Other insurers, including Aetna, Cigna, and Anthem (Blue Cross and Blue Shield), offer their own versions.
By finding out ahead of time, you can keep your doctor — at least for a little while — after your health insurance changes.
How to Get Transition of Care
Your new insurance provider can get you an application to fill out for transition of care. The new insurer will review your application and decide whether you can keep your doctor until you can move to a physician in network.
Fill out the application as quickly as possible so you can get approval to continue treatments with your current doctor. If you don’t get approval and keep seeing your current healthcare professional, you may not get the in-network rate for your treatment.
Ask Your Doctor for Help
Turn to your doctor if you still need some help navigating the situation. Additionally, your doctor may be able to help you fill out the form or provide insight into why you need to keep seeing them for at least a few more months.
Your doctor might also be able to help you make a smoother transition. If you can’t keep your doctor when your health insurance changes, they may be able to recommend another physician in network. That sort of recommendation can be valuable as you look for a new doctor you can trust.