My company is switching health care providers for the first time in many years. I have had the same primary physician for the past ten years and don't want to change. I fear though that the new plan won't list my physician as a primary care option. Is there anything I can do to ensure my doctor doesn't get pulled out from under me?
There are several avenues: First, prior to your companying changing providers, you can ask which carrier they are leaning towards then find out if your PCP is listed under that plan. If your PCP is not an “in-network” PCP provider, then find out if your physician is listed as an “in-network” PPO physician. Usually, you will find that your physician will be listed as a PPO, if not listed as an HMO provider. As mentioned earlier, more and more physicians are dropping off HMO plans as it is not cost efficient for them to have so many HMO patients. What happens is that HMO doctors spend an inordinate amount of time on HMO and their income from said HMO patients is not proportionate to the amount of time spent on these patients. The insurance companies pay the doctors differently for HMO patients than they due for PPO patients. Therefore, a majority of doctors are listed as PPO providers but not HMO providers.