What to know when your doctors get booted from your health insurance network : NPR

When a Missouri mom's health insurance company couldn't reach an agreement with her hospital, most of her doctors suddenly found themselves out of network. She wondered how she would care for her children or find new doctors. “For a family of five… where do we even start?”

Amber Wingler, 42, from Columbia, Missouri.

Last winter, Amber Wingler began receiving a series of increasingly urgent messages from her local hospital in Columbia, Missouri, telling her that her family's health care could soon be upended.

MU Health Care, where most of her family's doctors work, is mired in a contract dispute with Wingler's insurer, Anthem. The existing contract has expired.

Then, on March 31, Wingler received an email warning her that Anthem would cut the hospital off its network the next day. This made her reel.

“I know that they are constantly negotiating the contract … but I thought that the bureaucracy would not affect us. I’ve never been kicked offline like that before,” she said.

It was a terrible time.

Wingler's 8-year-old daughter, Cora, had unexplained bowel problems. Waiting lists for appointments with various pediatric specialists for diagnosis, from gastroenterology to occupational therapy, were long, ranging from weeks to more than a year.

(In a statement, MU Health Care spokesman Eric Maze said the health system is working to ensure children with the most urgent needs are seen as quickly as possible.)

Suddenly, specialist visits were offline for Cora. At several hundred dollars apiece, personal costs would quickly add up. The only other pediatricians Wingler found were in St. Louis and Kansas City, more than 120 miles away.

So Wingler delayed welcoming her daughter for several months while she tried to figure out what to do.

Across the country, contract disputes are common, with more than 650 hospitals engaged in a public spat with an insurer since 2021. become even more frequent As hospitals brace for roughly $1 trillion in federal health care cuts ordered by President Donald Trump subscription legislation signed the law in July.

Patients caught in a contract dispute have few good options.

“There is an old African proverb: when two elephants fight, the grass gets trampled. And unfortunately, in these situations, patients are often left in the dust,” said Caitlin Donovan, senior director of the Patient Advocate Foundation, a nonprofit that helps people access health care.

If you're feeling overwhelmed by a contract dispute between a hospital and your insurance company, here's what you need to know to protect yourself financially:

1. “Out of network” means you'll likely pay more.

Insurance companies enter into contracts with hospitals and other health care providers to set the rates they will pay for various services. When they reach an agreement, the hospital and most of the providers working there become part of the insurance company's network.

Most patients choose to use providers who are “in network” because their insurance will cover part, most or even all of the bill, which can be hundreds or even thousands of dollars. If you come across an out-of-network service provider, you may be on the hook for the entire tab.

If you decide to stick with the doctors you know, even if they are out of network, consider asking about cash discounts and the hospital's financial assistance program.

2. Disagreements between hospitals and insurers are often resolved.

When a health policy researcher at Brown University Jason Buchsbaum In a survey of 3,714 nonfederal hospitals in the U.S., he found that about 18% had a public dispute with an insurer sometime between June 2021 and May 2025, he said.

About half of those hospitals eventually fell out of the insurer's network, according to Buchsbaum's preliminary data. But most of these breakups end up being resolved within a month or two, he added. So your doctors may well end up back online, even after the split.

3. You may qualify for an exception to reduce costs.

Some patients with serious or complex conditions may qualify for an expansion of in-network coverage called continuity of care. You can apply for this extension by contacting your insurer, but be aware that this can be a lengthy process. Some hospitals have even created resources to help patients apply for this extension.

Wingler challenged her daughter by spending hours on the phone, filling out forms and sending faxes. But she said she didn't have the time or energy to do that for everyone in her family.

“My son was in physical therapy,” she said. “But I’m sorry man, just do the exercises you already have. I’m not fighting for you to be covered when I’m already fighting for your sister.”

It's also worth noting that if you are dealing with a medical emergency, for most hospital emergency services I can't take more than the patient's in-network rates.

4. You may have to wait to change your insurance company.

You may be thinking about switching to an insurance company that covers your favorite doctors. But keep in mind: Many people who choose insurance plans during the annual open enrollment period become locked into their plan for a year. Hospital insurance contracts are not necessarily issued on the same schedule as your “plan year.”

Certain life events for example, getting married, having a child, or losing a job may qualify you to change coverage outside of your annual open enrollment period, but your doctors leaving your insurance network is not a qualifying life event.

5. Going to the doctor can take a long time.

If the rift between your insurance company and hospital appears permanent, you may want to consider finding a new list of doctors and other health care providers that are in your plan's network. Where to start? Your insurance plan likely has an online tool that you can use to search for in-network providers near you.

But be aware that switching may mean waiting to establish yourself as a patient with a new doctor, and in some cases, traveling quite a distance.

6. It’s worth saving receipts

Even if your insurance and the hospital don't reach a deal before their contract expires, there's a good chance they'll reach a new agreement anyway.

Some people decide to postpone the appointment while they wait. Others show up for appointments and pay out of pocket. If so, save your receipts. When insurers and hospitals reimburse, deals are often made retroactively, so appointments you paid for out of pocket may eventually be covered.

End of the test

Three months after the contract between Wingler's insurance company and the hospital expired, the parties announced they had reached a new agreement. Wingler joined the throng of patients making appointments they had put off during the trial.

In a statement, Jim Turner, a spokesman for Anthem's parent company, Elevance Health, wrote: “We are approaching the negotiations with an emphasis on fairness, transparency and respect for all involved.”

MU Health Care's Maze said, “We understand how important timely access to pediatric specialty care is for families, and we are truly sorry that some parents have experienced frustration in scheduling visits following the completion of contract negotiations with Anthem.”

Wingler was glad her family was able to see their providers again, but her relief was tempered by her determination not to find herself in the same position again.

“I think we'll be a little more diligent when open enrollment hits,” Wingler said. “Before, we never bothered to look at our out-of-pocket coverage because we didn’t need it.”

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