My HMO dropped my doctor from their network. Is there anything I can do?

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Asked August 23, 2010

1 Answer


Your options are limited, but there are a couple of things that may be available. The first is to find out why your doctor was dropped and whether they can be readmitted to the network, and the other is to simply elect to use your doctor anyway, which may or may not cost you the full price out of pocket. If the doctor is a specialist, your coverage may be extended to that physician or particular procedure but will not extend to routine office visits.

Contact your doctor first, and ask them what they can tell you about being dropped from the plan. If your doctor isn't sure, it may that you find out through the insurance company. Your doctor may have opted out of the network, which means they would not be available, or been dropped for a variety of other reasons, including a perceived risk to the insurance company.

Your next option is to find out whether your health insurance will still cover procedures outside of the network. Most plans allow to you use non-network physicians but will not pay for any costs above what would have been paid to member physicians. If the costs of your procedure are greater than that, you will be forced to pay the remainder yourself. Some insurance plans do not make allowances for out of network visits, while others have procedures in place to help you get the required care at minimum cost to yourself.

Answered August 23, 2010 by Anonymous

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