|June 2023||Maximixe your HSA e-Newsletter||Vol. 19, Issue 6|
What To Do When You Don’t Like Your Doctor
Establishing a positive and trusting doctor-patient relationship is essential for receiving quality healthcare. However, there may be instances when you need to make a change.
Whether it’s due to communication issues, lack of trust, or a misalignment of values, it’s crucial to address your concerns and consider the possibility of switching physicians.
In this comprehensive guide, we will discuss how to change doctors if you’re not happy with them.
Specifically, we’ll discuss the process for changing your primary care doctor in several common scenarios: switching within an HMO, switching to another in-network doctor in a PPO, switching to an out-of-network doctor, switching to a health sharing plan, and switching to a direct primary care plan.
Remember, seeking the right healthcare provider is an important step towards receiving the quality care you deserve.
Switching to a New Primary Care Doctor within an HMO
If you are part of a Health Maintenance Organization (HMO) and wish to switch to a different primary care doctor within the network, follow these steps:
Research Available Doctors
Review the list of primary care doctors within your HMO network. Consider factors such as location, office hours, patient reviews, and any specific areas of expertise relevant to your healthcare needs.
Check Provider Directories
Consult your HMO’s provider directory or use their online search tool to find a new primary care doctor that aligns with your requirements. Pay attention to important details such as office locations, accepted insurances, and patient ratings.
Schedule a Consultation
Once you’ve identified a potential new primary care doctor, schedule an appointment for a consultation. This will allow you to meet the doctor in person, discuss your healthcare needs, and determine if their approach matches your expectations.
Inform Your Current Doctor
If you decide to switch, inform your current primary care doctor about your decision. Request the transfer of your medical records to the new doctor to ensure continuity of care.
Switching to a Different In-Network PPO Doctor
If you have a Preferred Provider Organization (PPO) plan and wish to switch to a different in-network doctor, your steps are a little different:
Understand Your PPO Network
Familiarize yourself with your PPO network of doctors by reviewing your insurance plan’s provider directory or contacting your insurance company. Confirm that the new doctor you’re considering is part of your network.
Research and Compare Doctors
Conduct thorough research on different doctors within your PPO network. Consider factors such as their experience, specialties, patient reviews, and accessibility to make an informed decision.
Contact Your Insurance Provider
Reach out to your insurance provider to ensure that the new doctor you’ve chosen is still in-network and covered by your plan. Inquire about any required documentation or notifications for the switch.
Schedule an Appointment
Once you have confirmed that the new doctor is within your PPO network, schedule an appointment for a consultation. Use this opportunity to discuss your healthcare needs, evaluate their compatibility with your preferences, and ensure a smooth transition.
Switching to an Out-of-Network Doctor
If you are considering switching to an out-of-network doctor, understand that your costs may increase substantially.
If you really want to use a doctor who is out of network over the long term, it may make sense to change your insurance carrier to one that includes your preferred doctor in their network.
Meanwhile, if the additional cost is acceptable to you, take the following steps:
Understand Out-of-Network Coverage
Review your insurance plan to understand the coverage and reimbursement policies for out-of-network providers. Be aware that out-of-network care often involves higher out-of-pocket costs.
Research Out-of-Network Doctors
Conduct thorough research to find doctors outside your network who specialize in the care you require.
Consider factors such as their expertise, experience, patient reviews, and accessibility.
Check Insurance Reimbursement
Contact your insurance provider to inquire about the reimbursement process for out-of-network care. Understand the required documentation, pre-authorization, and potential limitations or exclusions.
Assess Financial Considerations
Evaluate the financial implications of seeking out-of-network care.
Compare the cost of the out-of-network doctor’s services, potential reimbursement, and your out-of-pocket expenses against the benefits of receiving care from the specific doctor
Switching to Health Sharing
One of the notable advantages of most healthsharing plans over traditional health insurance is the absence of narrow care provider networks.
Unlike traditional health insurance plans, which often restrict your choice of healthcare providers, healthsharing plans generally allow you to use any provider of your choice.
This flexibility empowers you to seek care from the healthcare professionals you trust and have established relationships with.
Whether it’s a primary care physician, specialist, or a specific healthcare facility, most healthsharing plans recognize and accommodate your freedom to select the provider that best meets your healthcare needs.
This aspect of healthsharing plans ensures that you have the autonomy to make informed decisions about your healthcare and receive care from providers who align with your preferences and values.
For most healthy individuals, healthsharing plans are available at just a fraction of the cost of unsubsidized health insurance plans available on your state’s health insurance exchange.
Savings vary by the type of plan, your age, and the out-of-pocket annual member responsibility amount you select (akin to a health insurance deductible). However, savings of 40 to 50 percent compared to unsubsidized health insurance plans are not unusual.
If you currently receive a substantial subsidy, your health insurance plan may be less expensive than switching to health sharing.
No Open Enrollment Periods
While traditional Affordable Care Act-qualified health insurance plans impose limited enrollment periods, healthsharing plans allow you to sign up at any time.
However, they may impose waiting periods before the plan will share expenses related to certain pre-existing conditions.
Healthshare plans – also called medical cost-sharing plans – are especially cost effective for people in relatively good health with no pre-existing conditions, and who earn too much money to qualify for a large subsidy under the Affordable Care Act.
If you are interested in switching to a healthsharing program, here’s what to do. :
Research Healthsharing Programs
Explore different healthsharing programs available to determine the one that aligns with your healthcare needs, values, and budget. Consider factors such as monthly contributions, coverage limitations, and network flexibility.
You should also look into the plan’s religious requirements, if any. Some plans are entirely secular. Other faith-based healthsharing organizations may have specific requirements for beliefs, service attendance, etc.
Evaluate Coverage and Benefits
Review the coverage and benefits offered by the healthsharing program, including preventive care benefits, pre-existing condition restrictions, discounts available on prescription medications, maternity benefits, and anything else especially relevant to your specific healthcare needs.
Find Physician Networks That Provide Discounts To Your Healthshare Plan
Most healthsharing programs do not have restrictive care provider networks.
But some healthshare organizations negotiate discounted rates with some independent networks of providers. It’s worthwhile to know if your health sharing plan is one of them.
However, with healthsharing plans, you can typically use the provider of your choice. This flexibility allows you to seek care from healthcare professionals you trust and have established relationships with.
Enrollment and Transition
Once you’ve chosen a healthsharing program, follow their enrollment process. Inform your current doctor and insurance provider about your decision to switch, ensuring a smooth transition.
It’s a good idea to leave a few days of overlap between your old plan and your new health insurance plan, to avoid confusion and a possible break in coverage.
Switching to a Direct Primary Care Plan
Direct primary care plans are an innovative and money-saving solution to inefficient conventional fee-for-service based health insurance plans.
With direct primary care, you don’t go through an insurance company to access primary care services at all.
Instead, you pay a low flat monthly “subscription” to a primary care physician’s practice. In return, you get as many visits as you and your family need.
These plans are effective when combined with healthsharing plan that focuses on catastrophic medical events and specialist care, or health insurance plans with high deductibles.
These plans allow physicians to take on much lower patient loads, and allow them to spend much more time with each patient.
Many direct primary care patients find that they receive better care with much more “face time” with their doctors.
DPC memberships are great for routine care, wellness visits, minor emergencies and ailments, immunizations, medication management, and in some cases chronic disease management.
They typically do not include services that can’t be done in a doctor’s office, specialist care, surgeries, ER visits, mental health care, or hospitalization.
For that you’ll still need either a healthsharing plan or a major medical insurance policy.
If you’re considering a Direct Primary Care (DPC) plan, follow these steps:
Research DPC Providers
Research DPC practices in your area and explore the services they offer. Consider factors such as the range of services, accessibility, and costs associated with membership.
Schedule an Introductory Meeting
Contact the DPC providers you’re interested in and schedule introductory meetings to learn more about their approach to care, services provided, and membership fees. Use this opportunity to assess their compatibility with your healthcare needs and preferences.
Understand DPC Membership
Understand the details of the DPC membership, including the services covered, costs, and any additional benefits or discounts offered. Evaluate whether the membership model aligns with your healthcare goals and financial considerations.
Notify Your Current Doctor and Insurance Provider
Inform your current doctor and insurance provider about your decision to switch to a DPC plan. Coordinate the transfer of medical records and ensure a smooth transition of care.
Recognizing the signs of dissatisfaction, assessing your needs and priorities, and exploring different options for switching doctors are essential steps towards finding a healthcare provider who aligns with your expectations.
Whether you choose to switch within your current plan’s network, explore healthsharing programs, or consider alternative models like Direct Primary Care, prioritize your health and well-being by seeking a doctor who values effective communication, patient-centered care, and a strong doctor-patient relationship.
Remember, making an informed switch can lead to improved healthcare experiences and better health outcomes.
Click here to schedule an appointment, or call 800-913-0172 to get started.
To your health and wealth,
Wiley P. Long, III
President - HSA for America
The HSA for America Maximize Your HSA Newsletter is published monthly and emailed to subscribers at no charge. Subscribe now to stay on top of the critical information you need to know about health insurance, healthshare plans and managing your finances to achieve financial security.
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