Health Insurance: Frequently asked questions

My HMO dropped my specialist from its network. Don't I have any rights here?

You may have some rights, yes, but not necessarily extensive rights.

As part of managed care reform efforts, some states have begun passing laws to promote greater continuity of care. These laws require health plans to let certain people continue to be treated by their regular doctors after they're dropped from the network. Usually people who qualify under those laws are women who are in their third trimester of pregnancy, those with cancer, and people with a terminal disease.

To find out if your state has passed a similar law, contact your state insurance department. Also read Your rights when your health plan changes — for any reason to find out more.

Even if your state doesn't have such a law, you might have recourse through the HMO itself. Some health plans have their own policies that will allow you a specified number of visits to your former doctor, such as ob-gyns, neurologists, and psychologists, when they are dropped from the network or you enroll in a new health plan. Make sure you get preapproval (in writing, if possible) from the HMO to see them, lest you find yourself saddled with mounting bills that the health plan refuses to pay.

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