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Network outage: When your doctor disappears from your health plan's provider list





Before you signed up for a new health plan, you probably did your homework and checked that the doctor you had been seeing was in the plan's network. But when you call to make an appointment you learn the doctor no longer participates with your health plan.

You feel betrayed. Maybe you even feel like there was a bait-and-switch scam.

What's worse: "You're pretty much stuck until the next open enrollment," says Brian Luciani, CEO of Group Insurance Associates, a United Benefits Advisors partner firm, in Woodbridge, Conn. Unless you have a "qualifying life event," such as marriage, divorce, the birth of a child or change in job status, you must wait until the next open enrollment period to find another plan that includes your favorite doctors.

You still may be able to see your doctor and get partially reimbursed if your health plan provides out-of-network coverage, says Carol Taylor, employee benefit adviser with D&S Agency in Roanoke, Va., also a UBA firm. If you have a preferred provider organization or point-of-service plan, you can generally see an out-of-network provider. However, expect to pay more in co-insurance when you go out of the network, Taylor says.

In addition, you may be responsible for the difference between what the plan will pay for a covered service and what your doctor or health care provider charges. Here's more on using your health plan for doctors who don't take your insurance.

If you have an HMO and it doesn't provide any out-of-network coverage, you'd have to foot the entire bill yourself.

According to the Center on Health Insurance Reforms at Georgetown University's Health Policy Institute, since open enrollment for 2014 plans ended on March 31, some consumers are finding the networks they chose are changing or aren't as robust as they thought -- and consumers aren't happy about it.

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