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She liked her doctors but couldn't keep them

Posted: 7:00 PM, Aug 02, 2019
Updated: 2019-08-02 21:02:32-04
Mary and Andy looking at policy.jpg

COLORADO SPRINGS, Colorado — A word of caution when it comes to choosing your health insurance plan; the policy might not cover the doctor you're used to seeing.

It happened this summer to News 5 viewer Mary Bonser. She bought a policy on the state health insurance exchange last fall to help fill the gap between her retirement and Medicare eligibility.

Bonser is a retired human resources professional. So, she did her homework before buying.

"When I signed up for the plan, I looked at the provider directory and made sure that a whole bunch of the providers that I had seen were listed, and they were," she said.

But when Mary went to see one of those doctors they said they didn't accept her Kaiser Select plan. So, she started calling some of the other doctors that she thought were in the network. Only three of the eight accepted the policy.

"I was shocked to see that so many doctors would not accept that plan."

State regulators say this kind of thing can happen to anybody regardless of where you buy your plan.

"Doctors do fall in and out of the network, they terminate their contract in the middle of the year and it does happen," said Vincent Plymell, assistant commissioner of the Colorado Division of Insurance.

He went on to explain that when an insurance provider network get too small, there can be repercussions.

"We want to hear from folks on this because one of the things that we look into with insurance companies is do they have an adequate network of doctors in the area that they are selling insurance."

Plymell said the state requires quarterly audits of provider directories to make sure consumers are getting accurate information.

It turns out that Mary's Kaiser Select plan had a more limited provider directory than what Kaiser's website initially showed. She didn't know that at the time because the option for consumers to filter down to the Kaiser Select plans has a smaller font and can be easy to miss.

"Of course, you can't change plans until open enrollment, and it was a plan I can afford," she said. "So, I didn't want to change it to something else."

Mary was able to get treated by switching to a different medical group that was in network. Plymell said if you've been denied coverage or find yourself facing a potential network adequacy issue, they want to hear from you.

Contact them online at www.dora.colorado.gov/insurance or call toll free 1-800-930-3475.