Should a non-for-profit hospital be able to refuse a patient because of their insurance provider?

We recently received an announcement that a local hospital stated that they were not renewing contracting with a certain insurance company in 2024. The letter stated that if you used their doctors or facilities and had that particular insurance company then you would pay a higher co-pay to go to their doctors or facilities for care.

Nonprofit hospitals have a long history of providing health care for all, including those who cannot pay. Due to their charitable status, not-for-profit hospitals are exempt from most federal and state taxes but not from other taxes, like Social Security and Medicare taxes. The term “non-profit” or “not-for-profit” means that the hospital’s profits are returned to the hospital for its operations rather than to shareholders.

How Medicare Advantage plans work

Your plan will notify you that your provider is leaving your plan so you have time to choose a new one. You’ll get this notice if it’s a primary care or behavioral health provider and you have gone to that provider in the past three years. Your plan will help you choose a new provider and help you continue needed care that’s already in progress, or you can call us and we will help you find a doctor. When an in-network provider or benefit isn’t available or can’t meet your medical needs, most plans will help you get any medically necessary care outside the provider network (at the in-network cost sharing). Some plans offer non-emergency coverage out of network, but it usually costs more. Click here to learn more about Medicare Advantage plan types.

How we can help

If you experience issues going to an out of network provider please call our office at 260-483-2305 between January 2nd and March 31st to see if we can help. You should be able to go to any doctor or facility you chose with certain Advantage Plans. If the doctor or facility is considered out of network on your plan, you will pay a higher cost to continue using their services provided they agree to see you. We are dedicated to helping you understand how your Medicare plan works. Please click here to reach out to us if you have any questions.