A good doctor is hard to find, and is hard to give up. If you’ve considered switching insurance plans – like the 51% of companies that shopped for a new health plan this past year and 24% that changed carriers – you’ve heard the concerns from employees about losing their favorite physicians and continuity of care.
As an employer, you may think that once you pick a plan and open enrollment has come and gone, you’ve done your due diligence. But your employees’ experience with their health care will dictate much of their experience with your company. Ensuring that employees have access throughout the year is essential.
Why are providers covered under some insurance companies and not others? What happens when you decide to change the policy?
To illustrate, consider an employee that has a strong relationship with a specialist they see for a chronic condition. The employee has seen this doctor for years now, and has had no problems so far with insurance – even when changing plans in the past. When the employee goes for their next appointment after open enrollment, the physician orders some blood tests based on some concerns the employee had. Weeks later, the employee is hit with a bill for hundreds of dollars – for both the visit and the tests.
While that employee can continue seeing that doctor out-of-network (or going out-of-pocket and seeking a cash discount), these costs can add up. This can even happen when a member thinks they have done their research and chosen a facility that takes their insurance. In just six years, out-of-network bills from in-network hospitals increased from 32.3% to 42.8%. And given that 45% of single-person non-elderly households couldn’t pay $2000 for a medical bill, and 63% over $6,000, this is an unsustainable model.
If a physician becomes out-of-network when changing insurances, there are a couple of options to pursue.
If the employee is seeing a doctor for a specialty case (like for a high-risk condition or illness), they can petition their insurance for coverage to ensure continuity of care until they can safely switch physicians. They can also negotiate to see if there is a cash discount available if they pay out of pocket without insurance.
Yet, it doesn’t have to be this way. Even before a new plan is put into place, an employer should consider the potential impacts the decision may have on their employees that rely on consistent, specialty care. If they end up picking another traditional health plan that doesn’t account for seamless switching of specialty doctors, it may seriously impact their people.
One of the most frequently asked questions Poppins Health receives from members is if they will have to switch doctors under a new plan – especially specialists that have treated them for years. With a Poppins Health Plan, members can continue seeing their favorite doctors, with our member navigation team proactively reaching out before appointments and collecting information on doctors beforehand.
