Finding a doctor that you trust is a challenge. It’s the reason why people ask, “Can you keep your doctor under Obamacare?” Because if you’re not able to keep your doctor, you’ll likely have concerns about choosing a new one.
Your doctor knows your medical history, and you’re confident that he or she has your best interests in mind. And building that relationship took time.
Yes, President Obama famously said “if you like your doctor, you can keep your doctor.” But is that true? The short answer is yes. Yet it could mean changing your health plan or paying out-of-network prices.You can keep seeing the doctor you want, but it's not always a one-step process. Click To Tweet
Although the Affordable Care Act (also known as the ACA or Obamacare) has made coverage affordable for millions, some pre-ACA problems still exist.
People can lose their coverage, provider networks change, and doctors are often overbooked. Fortunately, there are ways to keep your doctor under all of these circumstances.
Scenario #1: You lose your current health plan.
If you lose your health plan outside of the nationwide Open Enrollment Period for any reason, you’ll qualify for a Special Enrollment Period. This means you have up to 60 days to enroll in a new plan. Just call to make sure your doctor is in-network, meaning that they accept your new insurance plan, before signing up.
Scenario #2: Your provider network changes.
If you receive a notice that your doctor is no longer in-network, changing health plans is the most affordable way to keep your doctor. You can only do this during open enrollment though; a network change won’t qualify you for a Special Enrollment Period.
Most insurance plans will still help you pay for out-of-network medical professionals. The catch? You’ll owe a much larger share of the costs than you would with in-network doctors.
Since insurers and doctors can renegotiate their contracts at any time, your doctor may also leave your network before you can switch plans. Here are some steps you can take to keep your doctor and minimize your expenses.
Call Your Insurance Company
Rules for going out-of-network vary, with some plans covering a larger share of the bill than others. Start by calling your insurance company to confirm the type of plan you have and explain why you’re unable to see an in-network provider.
If you have an acute illness, you can apply for ‘continuity of care’. This lets you receive care at in-network rates for 30 days, until the end of active treatment, or until you can safely switch physicians. Acute conditions vary by insurer, but typically include major surgery, cancer treatment, high-risk pregnancy, and ongoing care after a recent heart attack or stroke.
When it comes to specialist care, some health plans require a doctor’s referral. If your specialist is out of network, find out if the insurance company can make an exception. You may be able to get your treatment covered if you get approval prior to your visit.
Ask Your Doctor for Help
When your doctor is out-of-network, you’ll need to pay the higher fee during your appointment. Sometimes your insurance will cover your out-of-network care at a reduced rate; other times they won’t cover it at all.
However, if you ask for the paperwork you need to submit to your insurer, you’ll have a better chance of getting some expenses reimbursed. You can find claim forms on your insurance company’s website, and submit them along with the paperwork from your doctor.
If you need lab tests, ask your insurer which ones are in-network and request those at your next appointment. Doing so can save you hundreds of dollars.
Some doctors will also negotiate prices for patients who aren’t covered by insurance, so don’t be afraid to ask.
Call Your State Insurance Department
Your state insurance department is another great resource. You can call to find out what your rights are for going out-of-network. Your state may also have a consumer assistance program that will advocate and negotiate medical bills on your behalf.
Scenario #3: You have trouble getting an appointment.
An apple a day may help keep the doctor away, but eventually you’ll need to book a visit. Yet getting a timely appointment can be difficult. Depending on where you live, you may have to wait 21 days or more to see your doctor. Luckily, there are several ways to get an appointment sooner — without changing providers.
Patients often cancel or reschedule, leaving doctors with open slots on short notice. If you want to grab one for yourself, call early, follow up on waitlist requests, and be persistent.
Some Final Tips on How to Keep Your Doctor
Keeping your doctor may take some research and some flexibility. That can mean making an appointment at an inconvenient time or changing health plans during open enrollment.
If you get insurance through your employer, find out if you’re eligible to set up a Flexible Savings Account (FSA). Individuals with certain plans can also get a similar Health Savings Account (HSA). HSAs and FSAs let you set aside pre-tax funds to pay for medical expenses such as deductibles and copayments. (FSAs cover up to $2,700 in 2019.) Then, look into switching to a health plan with a broader network during your next open enrollment.
Lastly, always keep copies of your paperwork. Your insurance company may have questions about the care you received or may dispute the charges.
Remember, when it comes to keeping your doctor, you are your own best advocate!