Can my insurance change mid-year soclaims are getting paid differently?

UPDATED: Oct 20, 2011

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Can my insurance change mid-year soclaims are getting paid differently?

All of a sudden all of the doctors I use are now out-of-network and cannot be paid directly or at the same rate. I am midway through treatment for a broken leg and osteomylitis in the leg. I had already reached my deductible and out-of-pocket charges. Now with the second procedure for my leg. The first was around 5 months ago, then the policy changed the following month. The second procedure from last month is ongoing. I have convinced my insurance company to pay my orthopedic doctor in-network through the duration, however there area a lot more doctors involved with a hospital stay.

Asked on October 20, 2011 under Insurance Law, Indiana


SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 11 years ago | Contributor

Yes, the insurer can do this. It's not that your insurance--your policy terms, your premius, etc.--are changing, but that the doctors are dropping out of the network for one reason or another. Your insurance policy is a contract between you and the insurer; the terms and obligations, as affecting the two of you, cannot change. But your policy does not bind third parties, like doctors: they can exit--or enter--the network without regard to the impact on you, the same way any third-party service providers of any sort (e.g. contrators, lawyers, accountants, etc.) can change the way they get paid or what they charge regardless of what kind of insurance or other agreements you have which may provide reimbursement or coverage for like expenses. So the fact that your doctors have left the network obviously affects you, but there is nothing you can do about it.

IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.

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