What to Do When Your Doctor Leaves Your Health Plan

When you have a good relationship with your doctor, it’s almost like magic – especially if you’ve ever had a doctor you’ve disliked. After all, a good doctor-patient relationship can do wonders for the quality of your health care. You’re more likely to be open and candid, and the doctor is more likely to listen closely and provide better care.

That’s why it can be so disappointing to find that your doctor is no longer in your network, meaning your health insurance company no longer covers your visits, or covers them at a lower level. Although most people would love to stick with a trusted provider, out-of-network doctors’ fees are often too steep to pay out of pocket.

But for many who are insured through an employer or spouse’s employer, you can’t switch to an insurance policy that does cover your doctor until open enrollment later in the year. That is, unless your employer plan offers mid-year changes (very rare) or you experience certain life events such as marriage, divorce or a new job.

Still, as Trisha Torrey, founder of the Alliance of Professional Health Advocates, sees it, patients essentially have three main options when a doctor leaves their health plan: You could change health plans, when you’re able to do so to one that your doctor participates in if such coverage is available (it may not be among plans you have to pick from, like those offered by an employer); negotiate a cash price to continue seeing your doctor (the willingness of a doctor’s office to do this, the cost and what’s affordable for each individual will certainly vary considerably); or, of course, set about finding a new doctor.

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