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Jan 29, 2014

Have you noticed less providers in your new health insurance plan?  This is a trend many Americans are starting to experience with their new insurance plans.

We’re writing a series of articles to explain this trend: what networks are, why they matter to you and why they’re shrinking

As a reminder, insurance companies create insurance plans for you to choose from. Some with a wide network of providers (physicians & hospitals) for you to choose from while others have smaller networks with less to choose from.  Insurance plans with smaller networks are usually less expensive than those with larger networks. 

What if you already have a doctor you love and they’re not in your plan’s network?  You have three choices:

1) Choose a different plan

You might find a different plan with a network that includes your favorite doctor.  It might be more expensive and/or it might be with a different insurance company (Aetna vs. Blue Cross).  

If you get your insurance through your employer, you’ll have to wait until your company’s next open enrollment to get a new plan (unless you have a qualifying event that allows you to make a change mid-year – having a baby, marriage, divorce, etc.). If you’re self-employed, check with your insurance broker.  Each plan has its own rules for changing coverage. You’ll need to be aware of open enrollment requirements and allowable reasons for changing plans. 

2) Pay more for your doctor

You can keep your plan and keep your doctor, but you’ll probably pay higher “out of network” rates for those visits.  In many cases, it might be very worth your while to do this.  Since you’re probably “a regular” and your doctor doesn’t want to lose you either, work to negotiate with your doctor to see if they’ll give you in-network rates.  

Keep in mind, using an out-of-network doctor can also affect your deductible and out-of-pocket max.  Most plans have two deductibles and two out-of-pocket maximums – one for in-network costs and another for out-of-network costs (we’ll explore more about this in an upcoming article).  So, choosing an out-of-network provider can not only be more expensive on cost, but it can also affect how long you have to pay them before your insurance kicks in.

3) Go doc shopping 

You have the option of keeping your plan and changing your doctor. Thankfully, there are lots of good ones out there to choose from. And the insurance plans with smaller networks can be HUNDREDS OR THOUSANDS OF DOLLARS cheaper per year, so this option is worth considering!

In an upcoming article, we’ll explore what to do if you encounter an out-of-network charge from a provider.

Now it’s your turn! Did your favorite doctor drop off your provider’s network? What did you do?


Heidi has a passion for helping busy families control their healthcare dime, time and peace of mind! She writes articles to do just that, while keeping it fun and simple for her readers! She also speaks on healthcare issues and is the owner of

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Tanya Boyd
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