What To Do If Your Doctor Leaves Your Health Plan

If you have been fortunate enough to find a primary or specialty care doctor you love, it can be disappointing to say the least, when your doctor will no longer accept your health insurance plan. This means you’ll have to pay out of your own pocket to receive care from that point going forward. If you find out that your doctor is no longer within your insurance network, it can cause stress, anger and fear. You do, however, have several options on what you can do.

What to Do If Your Doctor Goes Insurance-Free

Doctors go insurance-free for several reasons, such as decreased reimbursement rates from health insurance companies, and excessive paperwork. In many cases, doctors who do not accept insurance have flat rates, or income-based sliding fee schedules, to keep care affordable. Other providers have monthly, quarterly, or annual fees, where their patients pay in advance, in exchange for a certain number of services or visits. Some may require payment at the time service is rendered each visit.

If your doctor goes insurance-free, talk to the billing office to determine how much care will cost. In some cases, it may not be much more than you would pay with health insurance coverage. Caution here, you may mistakenly feel that insurance is no longer important or necessary. Nothing could be further from the truth! The true cost of health care totally out of your own pocket could devastate you financially. Tests, lab work, prescription coverage, and hospitalization or emergency care can be thousands of dollars. In all cases, if you are determined to stay with your doctor no matter what, until you have a new “enrollment period” so you can switch health insurance options, it is best to pay your doctor, sometimes referred to “cash pay” and keep your insurance for all other necessary reasons. One unforeseen emergency without insurance is why you’ll want to keep insurance. One bout of cancer, an embolism, a heart attack, a strange infection, an accident, so many things that could happen that your 1 specific doctor cannot take care of is why you’d want to keep that insurance in place.

What to Do If Your Doctor Rejects Your Health Insurance

If your doctor rejects your health insurance plan, it is a good idea to call the health insurance company and state your case. In some cases, your health insurance provider may honor your appeal. Obviously, this does not happen often, but if your provider is providing a service that no one in your city/county provides, your insurance company may make exceptions for you to continue seeing your provider. You can also ask if your doctor’s office will submit an out-of-network claim on your behalf or provide you with necessary paperwork to file it yourself. You may also inquire about what you would pay out-of-pocket as a cash pay client.

New Insurance Plan? – Find Out If You Are Protected in Nevada

If you find yourself losing your health insurance plan and your new plan does not have your doctor in their network, now what do you do? There are some cases in which you are entitled to continue receiving care from your current medical provider, even if they are no longer within your plan’s network.

In Nevada, if you are actively undergoing medically necessary treatment, many insurance companies will work with their new members on transition of care. Depending on the patient’s need, there are times the insurance company may negotiate with the existing provider to complete their care.​

How to Find a New Doctor

• Get recommendations from friends
• Ask for a recommendation or referral from your doctor
• Familiarize yourself with your health insurance plan’s in-network provider list
• Ask your agent for a copy of, or where to look online for the “provider directory”
• Get yourself a great Broker – call Nevada Insurance Enrollment 702-898-0554
• Finding a new doctor may feel intimidating, but there are several steps you can take to make the process as hassle-free as possible.

Understanding Your Health Insurance Coverage with Nevada Insurance Enrollment

At Nevada Insurance Enrollment, health insurance agents can help you find your plan’s list of in-network providers and understand your coverage for primary and specialty care. If you do not currently have health insurance coverage, we can also help you find a plan that your preferred health care provider accepts.