Inside Medicare | How Do I Start Looking for a New Physician?

Janell Sluga Medicare & Individual Health Insurance Account Executive View Bio

Share this...

• Facebook
• Linkedin

Question:

I got a notification that my physician is retiring. I have to find a new one that takes my insurance. Where do I start?

Answer:

I have heard this more than a few times this month. We have a number of providers that have retired or are retiring. This may not be too much of a problem, but it could get more complicated depending on your insurance and the type of physician.

Very often our providers are part of a larger practice, and that group of physicians makes an effort to replace the physician before they retire or shortly after. So in some situations, you get a new provider automatically and your appointments may just transfer to the new provider. This is obviously the easiest situation for everyone.

There are times when your provider is not replaced, and therefore you have to move within the group to another provider. You may have to talk to the office and ask them what is happening for your particular situation. Realize that many patients are calling, so you need to be patient and understanding about the situation. The staff is answering the same questions again and again with all their patients.

If you have a choice of physicians that you can move to, you may want to think about what is important to you. Is it the gender of the physician, the work schedule for availability, or their educational background? Some physicians specialize, such as age, or obesity, or other factors. That information is usually on the company website, or you can find it by talking with the office manager of the practice.

If you are willing to move to the replacement provider, the other step you need to consider is notifying your insurance of the new doctor. This is really only necessary when it is your primary care provider that is changing. If it is a specialist, your insurance does not need to know about the switch.

Sometimes our insurance company notifies us that our physician is no longer considered in network. That doesn’t happen very often, but when it does, it is important to speak with the practitioner’s office to see what their next steps will be. Are they working with the insurance company to resolve the issue, has the physician retired and now the new physician will be in network with the insurance, or will you have to find a new provider or a new insurance plan? These are all possible outcomes to that situation. The most common is the physician has retired and as I mentioned usually the practice has replaced that individual and is working through the accreditation process with the insurance company, or it’s been resolved already.

If the physician is still working, but the contract with your insurance is no longer in network there, you must decide: do you want to change providers, or do you want to change insurance carriers? That is up to you. You should evaluate which is more important to you, the provider or insurance plan? Once you decide that, it’s time to try to make your desired switch.

Changing your insurance is not always possible. When you have a Medicare Advantage Plan, you may have an opportunity right now to change your insurance plan during January, February and March. That time period is called the Medicare Advantage Open Enrollment Period. During this time, you can reach out to Medicare or the source you used to get the product you currently have – if that’s a broker, be sure they go over plans that cover all of your doctors, not just the one who left your old network. If you worked directly with the insurance company themselves, you may have to reach out to another company, because your provider is probably out of network on all of their plans.

In finding a new provider and keeping the same insurance, I recommend reaching out to the insurance company you have and asking them to help you find a new provider who is accepted by the plan. That way you know whomever you choose will work with your insurance.

Changing doctors and insurance is never something we enjoy doing or look forward to doing. Use the resources of your insurance company, your insurance broker, and your provider’s office to help you through this change.