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Your rights when your health plan changes: Be your own advocate
By Insure.com

Even if your state doesn't have strong consumer-rights laws, it doesn't mean you are out of luck when your health plan changes in the middle of your medical treatment.

If you're undergoing long-term treatment with a doctor or specialist, you can ask your new health plan to give you a transition period for continued treatment with that doctor. Health plans may have informal policies that aren't publicized, and they might give you the option if you ask for it. If necessary, you might be able to bolster your case with a letter from your doctor explaining the need for that provider to continue your treatement.

Sometimes, though, the health plans don't even need to be asked. Your health plan itself might voluntarily opt to let you continue to see your doctor, even if it doesn't have to under state law.

That was the case at Aetna U.S. Healthcare, for instance, when it was in the midst of a protracted contract dispute with a system of hospitals and doctors in Virginia that saw many providers terminating their participation in the HMO's network. Aetna said that to ensure continuity of care, it would allow some patients, "where appropriate," to continue ongoing treatment with their current doctors.

Remember, there is no harm in asking.

Or perhaps your employer has made changes to your health plan for the coming year, such as dropping prescription drug coverage or switching to a plan with fewer providers in the network. This is where you and your co-workers may be able to lobby successfully for a change. After all, employers commonly use group health insurance as a way to attract and retain good employees. If the health plan is causing more upset than happiness, it's not doing your employer any good. While you'll have to live with the new plan for a year, you can lobby for better change for the next enrollment period.

 

Last Updated March 12, 2008
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