In network doctors not showing up

[somarco]

I mean I guess they could not be in network, but only one doctor in the practice accepting a huge plan in the area yet not one other doctor in the same office? It didn't seem plausible to me.

Individual doctors have an NPI number that is not the same as the practice NPI. It is not unusual in primary care practices where there are a number of providers (MD, PA, NP, MSSW, etc.) for some providers to participate in MAPD plans while others do not.

You have to research the practice AND the individual provider.

The GYN practice my wife uses does not participate in OM but one of the physicians opted in to Medicare and will see OM patients.

 

[jack3454]

That's incorrect . Sometimes one dr in a practice only shows up yet I write it . Never had an issue to this day of the other drs in office not taking it .

Good to know, thanks

Is the doctor's office facility in network? If it is, and the doctor not showing up is W2 employed, then they are in network. I find this happens a lot when people give me the name of their PA, instead of their actual PCP.

That I didn't check, I have been doing all individual searches. I will see if I can find the practice itself in the look up tool.

I do know her PCP is now a CRNP, not a MD. Does this matter?

 

[Fisher]

I do know her PCP is now a CRNP, not a MD. Does this matter?

It can. Find the MD or DO that the NP practices under and plug that name into the provider directory.

 

[straightnochaser]

Good to know, thanks



That I didn't check, I have been doing all individual searches. I will see if I can find the practice itself in the look up tool.

I do know her PCP is now a CRNP, not a MD. Does this matter?

You seem very very new to this? Do you have an upline or mentor that helps you?

 

[jack3454]

You seem very very new to this? Do you have an upline or mentor that helps you?

I am new, sorry. I do but they are useless. Probably going to change companies next year.

 

[Fisher]

I am new, sorry.

Don't apologize for that - we were all noobs at one point. Some in here remain noobs.

 

[yorkriver1]

I am new, sorry. I do but they are useless. Probably going to change companies next year.

If you can find the area sales manager for the insurance company for the plan you are hoping to use, they are often more helpful. I just did that for a situation where it turns out the practice is in the network and they bill MD's under the practice. I didn't want to write the plan until I had the carrier rep assure me that is legit. Sometimes the reps are the greatest, after we are around a while we tend to find out who knows things.
PS, changed uplines within the 1st few years, if people have, shall we say, "ONE JOB" and can't answer questions for a newer rep, time to find an upline who at least knows where to look.

 

[renee15]

Rally- UHC provider search tool isn't listing providers who are not accepting new patients
I've spent a ton of time researching one provider-she shows up on Individual plan provider network

In the next few years-people on Med Supps will have easier access to care as more and more providers do not like haggling with MAPD carriers

 

[LIFL]

It's a hamster-wheel, essentially, to verify accepted insurance plans and in-network provider(s) for Medicare Advantage Plans for the following year. Wait for the fallout during Medicare Advantage Open Enrollment(Dis-enrollment) Period. According to my physician wife, it can take a month or 2 just to accept the Health insurance plan and become an in-network provider.