If your doctor is dropped from your insurance

Don't panic. Here are four steps to take.

Published: July 10, 2014 06:00 AM

Last fall thousands of people with UnitedHealthcare Medicare Advantage plans learned that their doctors would be cut from the health-plan network. Many of my fellow neurologists, who care for patients with such chronic conditions as multiple sclerosis and Parkinson’s disease, were dropped. Their patients were left scrambling to find new doctors. People with other serious conditions, such as cancer, glaucoma, and emphysema, found themselves in the same boat.

UnitedHealthcare wasn’t the only insurer dropping providers, though it was the biggest. Other insurers have also recently made cuts to their provider networks. Suddenly finding out that your doctor is no longer covered by your plan doesn’t necessarily mean that you have to part ways. But you’ll need to do some research to find a new plan or work out a new arrangement with the doctor. Here are the steps to take, in order:

1. Appeal to your insurance company

Send a letter in support of your doctor’s care. If there’s no other physician in the plan within a reasonable traveling distance, describe the hardship. You could also contact an organization that focuses on your ailment, such as the American Cancer Society or the National Multiple Sclerosis Society, to ask whether it might take up the cause, especially if a lot of patients are affected. Also find out whether your state requires insurance companies to pay for a certain period of continuity of care, during which you may continue to use the same doctor under certain circumstances (you’re undergoing treatment for a chronic condition, for example).

2. Find another plan

If your insurer doesn’t change its mind (which, alas, it probably won’t), look for another Medicare Advantage plan that has your doctor on its panel, or switch to original (regular) Medicare. You don’t have to wait until the annual open enrollment period. The Centers for Medicare & Medicaid Services announced in April that it would allow enrollees to switch plans midyear if they were affected by a significant provider network termination. And you can still change your plan during open enrollment, which is Oct. 15 through Dec. 7.

3. Work out a financial arrangement with your doctor

Many of my patients have elected to continue to see me even though I’m not in their network anymore. In most cases, I give them a substantial discount from my regular fees. Initiate a conversation with your doctor by asking whether she would take a percentage off her regular fees or accept the discounted rate that the insurance company paid.

4. Look for a new doctor

As difficult as it can be to leave a physician you trust, there are more ways than ever to help you find a new one. Get names from doctors, nurses, friends, and co-workers, and check to see whether they’re on your health plan. Make sure that the doctors you consider are board-certified and have no history of sanctions or misconduct complaints. (You can do so at your state’s department of health website.) You can also look up whether a doctor has ties to the drug industry on ProPublica's free site. And last, see which hospital he or she is affiliated with and look up its safety score in our hospital Ratings, avail­able to online subscribers.

Orly Avitzur, M.D.

Medical Adviser
Editor's Note:

This article also appeared in the August 2014 issue of Consumer Reports on Health.

E-mail Newsletters

FREE e-mail Newsletters! Choose from cars, safety, health, and more!
Already signed-up?
Manage your newsletters here too.

Health News


Cars Build & Buy Car Buying Service
Save thousands off MSRP with upfront dealer pricing information and a transparent car buying experience.

See your savings


Mobile Get Ratings on the go and compare
while you shop

Learn more