What happens when your doctors are no longer in your insurance company’s network?

Last winter, Amber Wingler began receiving a series of increasingly urgent letters from her local hospital in Columbia, Missouri, informing her that her family’s medical care might soon be affected.

MU Health Care, where most of the doctors his family employs, has been embroiled in a contract dispute with Anthem, Wingler’s health insurance company. The current contract was about to expire.

Then, on March 31, the woman received an email alerting her that the next day the hospital would no longer be in the Anthem network.

The news left her dazed.

“I know they negotiate contracts all the time…but it seemed like a simple bureaucratic procedure that wouldn’t affect us,” he said. “I’ve never been excluded from an insurance company network like this before.” This moment could not be less appropriate.

Question: When a mother’s health insurance company in Missouri couldn’t reach an agreement with her hospital, most of her doctors were suddenly out of network. She wondered how she would provide medical care for her children or how she would find new doctors. “For a family of five… where do we start?” —Amber Wingler, 42, from Columbia, Missouri

Wingler’s 8-year-old daughter, Cora, had bowel problems for no apparent reason. Waiting lists to see many pediatric specialists for diagnoses, from gastroenterology to occupational therapy, were long, ranging from weeks to more than a year.

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

Suddenly, Cora’s specialty visits were out of her insurance network. After several hundred dollars each, the cost would have skyrocketed. The only other pediatric specialists Wengler found in-network were in St. Louis and Kansas City, both more than 120 miles away.

So Wingler postponed her daughter’s doctor’s appointments for months while she tried to decide what to do.

Contract disputes are common across the country, with more than 650 hospitals involved in public disputes with insurance companies as of 2021.

Y It could become more frequent As hospitals prepare to cut nearly $1 billion in federal health spending, as mandated by law Law badge President Donald Trump signed it into law in July.

Patients caught in a contract dispute have few viable options.

“There’s an old African proverb that says, ‘When two elephants fight, the grass gets crushed,'” said Caitlin Donovan, director of Patient Advocate, a nonprofit that helps people who have difficulty accessing health care. “Unfortunately, in these situations, the patients are often the grass.”

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

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

Insurance companies negotiate contracts with hospitals and other medical providers to determine the prices they will pay for various services. When they reach an agreement, the hospital and most of the providers who work there become part of the insurance company’s network.

Most patients prefer to see “in-network” providers because their insurance covers part, most, or even all of the bill, which can be hundreds or thousands of dollars. If you see an out-of-network provider, you may have to pay the full bill.

If you decide to stick with your regular doctors even if they are out of network, you can ask about getting a cash discount and the hospital’s financial assistance program.

2. Disputes are usually resolved between hospitals and insurance companies.

Jason BuxbaumThe Brown University health policy researcher examined 3,714 non-federal hospitals in the United States and found that between June 2021 and May 2025, 18% had a public dispute with a health insurance company.

Ultimately, about half of these hospitals dropped out of the insurer network, according to Buxbaum’s preliminary data. He added that most of these separations are resolved within a month or two. Therefore, it is very likely that your doctors will become part of the network again, even after separation.

3. You can qualify for an extension that allows you to reduce costs.

Certain patients With serious or complex conditions They may be eligible for an extension of in-network coverage, called continuity of care.

You can request this extension by contacting your insurance company, but the process can be long. Some hospitals have set up resources to help patients apply.

Wingler has gone through the ordeal her daughter did: long hours on the phone, filling out forms and sending faxes.

But he said he doesn’t have the time or energy to do that for his whole family.

“My son was undergoing physical therapy,” she said. “But I’m so sorry, son,” he said to himself, “keep going with the exercises you have to do. I won’t fight until you have coverage too, while I’m already fighting for your sister.”

It is also important to consider whether this is a medical emergency: in most emergency departments and hospitals They cannot charge patients additional fees of your network rates.

4. You may have to wait to change insurance companies.

Maybe you’re considering switching to an insurance company that covers your favorite doctors. But keep in mind that many people who choose their health plans during the annual open enrollment period become locked into their plan for a year. Contracts between insurance companies and hospitals don’t necessarily match your plan year.

some Life eventssuch as getting married, having a child, or losing your job, may allow you to change insurance outside of the annual open enrollment period, but your doctors leaving your insurance network is not considered a life event that allows you to do so.

5. Finding a new doctor can take a long time.

If the breakup between your insurance company and the hospital seems final, you might consider looking for a new list of doctors and other providers in your plan’s network. Where to start? Your plan likely has an online tool to find in-network providers near where you live.

But keep in mind that changing doctors may mean waiting until you become a patient with a new doctor and, in some cases, having to move on.

6. Receipts are worth saving.

Even if your insurance and the hospital do not reach an agreement before your contract expires, there is a possibility that you will reach a new agreement.

Some patients decide to postpone their appointments while they wait. Others keep their appointments and pay out of pocket. If this is your case, save your receipts. When insurance companies and hospitals reach a settlement, it’s usually applied retroactively, so appointments you paid for out of pocket may be covered after all.

The end of the ordeal

Three months after the contract between Wingler’s insurance company and the hospital expired, the two sides announced a new agreement. Wengler joined the crowd of patients rescheduling appointments they had postponed during the crisis.

In a statement, Jim Turner, a spokesman for Elevance Health, Anthem’s parent company, wrote: “We approached the negotiations with a focus on fairness, transparency, and respect for all those affected.”

“We understand the importance of timely access to specialty pediatric care for families and are deeply sorry for the frustration some parents felt trying to schedule appointments after contract negotiations with Anthem were resolved,” said MU Health Care’s Maze.

Wingler was happy that his family could see their doctors again, but his relief was tempered by his determination not to find himself in the same situation again.

“I think we’ll be a little more cautious when the open enrollment period comes around,” Wengler said. “We never bothered to review our prose coverage because we didn’t need it.”