Most health plans give you the best deal on services when you see a doctor who has a contract with your health plan. While you may be able to see doctors who don’t contract with your plan, visiting an “in-network” provider usually means you’ll have lower out-of-pocket costs.
Finding a doctor in your plan
To find out if your doctors and other health care providers are covered by your new Marketplace plan, or to find a covered provider if you don’t have one yet:
- Visit your health plan’s website and check their provider directory, which is a list of the doctors, hospitals, and other health care providers that your plan contracts with to provide care.
- See your health plan’s provider directory. You can get this by contacting your plan, visiting the plan’s website, or using a link that you’ll find on the plan description in your Marketplace account. 3. Call your insurer to ask about specific providers. This number is on your insurance card and the insurer’s website.
- Call your doctor’s office. They can tell you if they accept your health plan.
- Call the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325). A trained representative can help you find your insurer’s number
Is there an appeals process if I go to my regular doctor and find out later that my new plan doesn’t cover them?
Yes. If your health insurance company doesn’t pay for a visit to the doctor, you have the right to appeal the decision and have it reviewed by an independent third party. Learn about the appeals process.
Source: HealthCare.gov, “Getting regular medical care.” http://www.healthcare.gov website. Accessed December 2, 2015. https://www.healthcare.gov/using-your-new-marketplace-coverage/#part=3
© Copyright 2016. All rights reserved. This content is strictly for informational purposes and although experts have prepared it, the reader should not substitute this information for professional insurance advice. If you have any questions, please consult your insurance professional before acting on any information presented. Read more.