Recently Lost Your Doctor?

You can ask your doctor what other types of insurance they accept such as original Medicare or a Medicare supplemental policy.

Starting January 1, 2024 Scripps Clinic and Scripps Coastal will not be contracted to accept any Medicare Advantage Plans in network.

If your doctor no longer accepts your insurance plan you can find another doctor in your plans network who is accepting new patients.

Yes. Doctors aren’t required to accept health insurance plans or to accept the rates insurance companies contract to pay them. The Affordable Care Act looked to improve health insurance access, but it didn’t resolve the issue of rising costs and lower reimbursements offered by some payers.

Physicians negotiate the price of treatment with health insurers. The health insurance company sets the rates that it will pay the doctor. Insurance companies may also include quality metrics that doctors must meet to get full reimbursement. Insurers set rates, but that doesn’t mean that the physician must agree to these rates.

The Direct Primary Care (DPC) model is a practice and payment model where patients/consumers pay their physician or practice directly in the form of periodic payments for a defined set of primary care services.

The cash-only term simply means that patients pay at the time of service. They may pay with a credit or debit card, check or cash. The key is that no third-party payers are involved to complicate the transaction or the relationship. In its purest form, cash-only practice means not participating with any insurer. The newest variation on cash-only practice is concierge or membership practice in which physicians have a small panel of patients who can afford to pay high out-of-pocket costs for their health care. Patients usually pay a combination of an annual retainer fee and fee-for-service in exchange for value-added services, such as 24/7 access to the physician and house calls.

If you learn that your health care provider doesn’t take Medicare, you have options. Perhaps you could negotiate a discounted or sliding scale fee or see if the practice offers flexible financing options.

If you have an HMO plan, or other managed care plan, the plans coverage language is very clear about using in-network providers, if there are such providers in your service area. Out of network services are generally not covered.

Heath plans must cover emergency care, even if you do not go to a hospital in your plan’s network. Any emergency room must treat you until you are well enough to be moved to a hospital in your health plan’s network. Your plan must also cover emergency care when you travel outside of your plan’s service area.

When your doctor drops out of your plan network, you’ll probably be warned. That means you would generally receive a letter in the mail informing you of an upcoming change. You can call your plans member service center to inquire what doctors are available in your plan network.