Required to change providers?

[SESmama]

What is the name of your state (only U.S. law)? GA

Yes, I looked and did not find a definitive answer.

Is it the prevailing decision that a child would have to change a doctor if it is not in-network under the insurance plan provided by the NCP.

Ex is adding son to his new wife's plan. I have no issue with it except only one of his doctors is in-network. Our son has issues with adults (part of his SPD) and has developed a trust with these doctors. I would prefer not to have to change doctors if it is not a prevailing ruling.

Just looking for a general view.

 

[mistoffolees]

What is the name of your state (only U.S. law)? GA

Yes, I looked and did not find a definitive answer.

Is it the prevailing decision that a child would have to change a doctor if it is not in-network under the insurance plan provided by the NCP.

Ex is adding son to his new wife's plan. I have no issue with it except only one of his doctors is in-network. Our son has issues with adults (part of his SPD) and has developed a trust with these doctors. I would prefer not to have to change doctors if it is not a prevailing ruling.

Just looking for a general view.

It's really going to depend on circumstances.

As a general guideline, if there are legitimate reasons for choosing the insurance that ex chooses, then you could continue to choose an out-of-network doctor, but the court MIGHT order you to pay the difference in cost.

OTOH, you are free to get your own insurance and use whatever doctors you want, but can't expect your ex to pay that.

Now, it's possible that if the child's doctors were able to convince the court that a change in doctors would be harmful to the child that you might be able to get ex to pay for some (or all) of the extra charge, depending on what your court orders say. But it's going to be hard for a doctor to convince the court that "I'm the only one who can treat this child".

You'd really have to bounce it off an attorney - bring in your court order and a letter from the doctor as to why a change of physician would be harmful.

Most likely? You're probably going to have to change doctors unless you want to pay the incremental cost of staying where you are.

 

[LdiJ]

It's really going to depend on circumstances.

As a general guideline, if there are legitimate reasons for choosing the insurance that ex chooses, then you could continue to choose an out-of-network doctor, but the court MIGHT order you to pay the difference in cost.

OTOH, you are free to get your own insurance and use whatever doctors you want, but can't expect your ex to pay that.

Now, it's possible that if the child's doctors were able to convince the court that a change in doctors would be harmful to the child that you might be able to get ex to pay for some (or all) of the extra charge, depending on what your court orders say. But it's going to be hard for a doctor to convince the court that "I'm the only one who can treat this child".

You'd really have to bounce it off an attorney - bring in your court order and a letter from the doctor as to why a change of physician would be harmful.

Most likely? You're probably going to have to change doctors unless you want to pay the incremental cost of staying where you are.

I am not sure that is correct in this instance. If dad was not changing the children's insurance the doctors would not be out of network. Therefore it could be argued that the children's doctors should not have to change, just because dad made the decision to change their insurance...or that mom would have to pony up the extra costs of dad making that decision.

 

[mistoffolees]

I am not sure that is correct in this instance. If dad was not changing the children's insurance the doctors would not be out of network. Therefore it could be argued that the children's doctors should not have to change, just because dad made the decision to change their insurance...or that mom would have to pony up the extra costs of dad making that decision.

As I said - it depends on whether Dad has a good reason to change insurance.

If the company plan has changed, Dad may not have any choice. In which case the above applies. Or perhaps there's another good reason for the change (maybe spouse has a life-threatening issue which is better covered at a different hospital).

If Dad is changing it merely to spite Mom, then you might be right, but in spite of all the claims here, I really don't think very many people are going to mess with their insurance just to bug the other parent.

 

[OHRoadwarrior]

We have a good relationship with our doctor. He will join another network to keep us in. They can also volunteer to adjust their write off %. Have you asked?

 

[nextwife]

I am not sure that is correct in this instance. If dad was not changing the children's insurance the doctors would not be out of network. Therefore it could be argued that the children's doctors should not have to change, just because dad made the decision to change their insurance...or that mom would have to pony up the extra costs of dad making that decision.

A few years ago, my employer changed our insurance coverage from United Healthcare to Blue Cross, so my daughter and we had to change doctors. Another time, the entire clinic group with which we had most of our doctors left our insurance plan and became out of network.

In today's insurance environment, people do need to be willing to change doctors to stay in network. In our case, the network changed, twice, it was not our choice. This stuff happens all the time. It is no longer possible to demand one's doctors not change, unless one is willing to pay out of network cost.

If mom and dad were still together as a couple, and it were economically necessary to change networks, you don't think they would do so?

 

[cbg]

I am not sure that is correct in this instance. If dad was not changing the children's insurance the doctors would not be out of network. Therefore it could be argued that the children's doctors should not have to change, just because dad made the decision to change their insurance...or that mom would have to pony up the extra costs of dad making that decision.

You're assuming that Dad had a choice in the matter. What if the original plan is no longer being offered?

 

[nextwife]

You're assuming that Dad had a choice in the matter. What if the original plan is no longer being offered?

Or is no longer the cost effective option. Sometimes an employer changes from one option to three, with varying degrees of OOP coverage, and the old plan is too expensive. People don't just switch health coverage like they do auto policies. Odds are, if dad switched, there was an economically valid reason.

 

[cbg]

Quite true. There could be half a dozen valid reasons for the change that have nothing to do with Dad simply making a careless decision to change benefits without checking.

 

[SESmama]

The NCP never had insurance

The policy is his wife's not his. She does have the option, at the same exact cost, to move to the same insurance company son is already under with my insurance. Better benefits from what I read on the SPD. So he isn't changing he is adding son to his wife's policy so they will end up with a family policy.

I think the best option would be for me to continue to cover son and ensure we don't have to change doctors. The NCP's can be used as secondary insurance.

Two of the doctors were on the plan they want to sign him up under but they refuse to rejoin as they were often paid late or not the full amount. I had nightmare issues with the company they want to put him under. That was a few years ago though.