My psychiatrist is dropping out of my health plan. I called 12 other places that take the plan, but either they are not accepting new patients, they have retired, or they don’t have a psychiatrist any longer. If the plan cannot find me a psychiatrist, what happens? Am I supposed to go without?
Dear “Homeless” Patient,
You most certainly will not be expected to go without services. The Affordable Care Act requires plans to give members a “sufficient choice of providers”. Having no psychiatrist available to you would put the plan on the wrong side of the rules.
The plan will have to connect you with a psychiatrist who is accepting new patients, or allow you to continue seeing your current doctor. They may offer you a short-term (90-day, for example) extension, during which your current doctor would be paid as if he were still part of the plan. After that, if they still don’t have a psychiatrist, they may offer to make a special arrangement with your doctor. In fact, they may be required to make this arrangement.
You may have to stand up for yourself in dealing with the health plan. Your doctor can also help you in this. If you do not get the care that you need, you can contact your state’s insurance regulatory bureau. The state will have people whose job it is to help you get a fair and equitable decision from the plan.