Out-of-network and on your own? What to do if your insurer drops your doctors

"Last winter, Amber Wingler started getting a series of increasingly urgent messages from her local hospital in Columbia, Missouri, letting her know her family's health care might soon be upended. MU Health Care, where most of her family's doctors work, was mired in a contract dispute with Wingler's insurance company, Anthem. The existing contract was set to expire. Then on March 31, Wingler received an email alerting her that the next day, Anthem was dropping the hospital from its network. It left her reeling."

"Waitlists to see various pediatric specialists to get a diagnosis, from gastroenterology to occupational therapy, were long — ranging from weeks to more than a year. Suddenly, the specialist visits for Cora were out-of-network. At a few hundred bucks apiece, the out-of-pocket cost would have added up fast. The only other in-network pediatric specialists Wingler found were in St. Louis and Kansas City, both more than 120 miles away."

Amber Wingler, a 42-year-old mother in Columbia, Missouri, learned that Anthem would drop MU Health Care from its network after contract negotiations failed, making most of her family's doctors out-of-network. Her 8-year-old daughter, Cora, faced long waitlists for pediatric specialists, from gastroenterology to occupational therapy, with waits ranging from weeks to over a year. Out-of-pocket costs for out-of-network specialist visits were several hundred dollars each, and the nearest in-network specialists were more than 120 miles away. Wingler postponed appointments while seeking options. Nationwide, more than 650 hospitals have had public disputes with insurers since 2021.

Read at www.npr.org