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Last winter, Amber Wingler started getting a series of increasingly urgent messages from the local hospital in Columbia, Missouri, letting her know her family\u2019s health care might soon be upended.<\/p>\n
MU Health Care, where most of her family\u2019s doctors work, was mired in a contract dispute with Wingler\u2019s health insurer, Anthem. The existing contract was set to expire.<\/p>\n
Then, on March 31, Wingler received an email alerting her that the next day Anthem was dropping the hospital from its network. It left her reeling.<\/p>\n
\u201cI know that they go through contract negotiations all the time \u2026 but it just seemed like bureaucracy that wasn\u2019t going to affect us. I\u2019d never been pushed out-of-network like that before,\u201d she said. \u00a0<\/em><\/strong><\/strong><\/p>\n The timing was awful.<\/p>\n The query: When a Missouri mom\u2019s health insurance company couldn\u2019t come to an agreement with her hospital, most of her doctors were suddenly out-of-network. She wondered how she would get her kids\u2019 care covered or find new doctors.<\/em><\/strong> <\/strong>\u201c<\/strong>For a family of five, \u2026 where do we even start?\u201d<\/em><\/strong><\/strong><\/p>\n \u2014 Amber Wingler, 42, in Columbia, Missouri<\/strong><\/strong><\/p>\n Wingler\u2019s 8-year-old daughter, Cora, had been having unexplained troubles with her gut. Waitlists to see various pediatric specialists to get a diagnosis, from gastroenterology to occupational therapy, were long \u2014 ranging from weeks to more than a year.<\/p>\n (In a statement, MU Health Care spokesperson Eric Maze said the health system works to make sure children with the most urgent needs are seen as quickly as possible.)<\/p>\n Suddenly, the specialist visits for Cora were out-of-network. At a few hundred bucks a piece, the out-of-pocket cost would have added up fast. The only other in-network pediatric specialists Wingler found were in St. Louis and Kansas City, both more than 120 miles away.<\/p>\n So Wingler delayed her daughter\u2019s appointments for months while she tried to figure out what to do.<\/p>\n Nationwide, contract disputes are common, with more than 650 hospitals having public spats with an insurer since 2021. They could become even more common<\/a> as hospitals brace for about $1 trillion in cuts to federal health care spending prescribed by President Donald Trump\u2019s signature legislation<\/a> signed into law in July.<\/p>\n Patients caught in a contract dispute have few good options. \u201cThere\u2019s that old African proverb: that when two elephants fight, the grass gets trampled. And unfortunately, in these situations, oftentimes patients are grass,\u201d said Caitlin Donovan, a senior director at the Patient Advocate Foundation, a nonprofit that helps people who are having trouble accessing health care.<\/p>\n If you\u2019re feeling trampled by a contract dispute between a hospital and your insurer, here is what you need to know to protect yourself financially:<\/p>\n 1. \u201cOut-of-network\u201d means you\u2019ll likely pay more.<\/strong><\/strong><\/p>\n Insurance companies negotiate contracts with hospitals and other medical providers to set the rates they will pay for various services. When they reach an agreement, the hospital and most of the providers who work there become part of the insurance company\u2019s network.<\/p>\n Most patients prefer to see providers who are \u201cin-network\u201d because their insurance picks up some, most, or even all of the bill, which could be hundreds or thousands of dollars. If you see an out-of-network provider, you could be on the hook for the whole tab.<\/p>\n If you decide to stick with your familiar doctors even though they\u2019re out-of-network, consider asking about getting a cash discount and about the hospital\u2019s financial assistance program.<\/p>\n 2. Rifts between hospitals and insurers often get repaired.<\/strong><\/strong><\/strong><\/p>\n When Brown University health policy researcher Jason Buxbaum<\/a> examined 3,714 nonfederal hospitals across the U.S., he said, he found that about 18% of them had a public dispute with an insurance company sometime from June 2021 to May 2025.<\/p>\n About half of those hospitals ultimately dropped out of the insurance company\u2019s network, according to Buxbaum\u2019s preliminary data. But most of those breakups ultimately get resolved within a month or two, he added. So your doctors very well could end up back in the network, even after a split.<\/p>\n 3. You might qualify for an exception to keep costs lower.<\/strong><\/strong><\/strong><\/strong><\/p>\n Certain patients with serious or complex conditions<\/a> might qualify for an extension of in-network coverage, called continuity of care. You can apply for that extension by contacting your insurer, but the process may prove lengthy. Some hospitals have set up resources to help patients apply for that extension.<\/p>\n Wingler ran that gantlet for her daughter, spending hours on the phone, filling out forms, and sending faxes. But she said she didn\u2019t have the time or energy to do that for everyone in her family.<\/p>\n \u201cMy son was going through physical therapy,\u201d she said. \u201cBut I\u2019m sorry, dude, like, just do your exercises that you already have. I\u2019m not fighting to get you coverage too, when I\u2019m already fighting for your sister.\u201d<\/p>\n Also worth noting, if you\u2019re dealing with a medical emergency: For most emergency services, hospitals can\u2019t charge patients more<\/a> than their in-network rates.<\/p>\n 4. Switching your insurance carrier may need to wait.<\/strong><\/strong><\/strong><\/p>\n You might be thinking of switching to an insurer that covers your preferred doctors. But be aware: Many people who choose their insurance plans during an annual open enrollment period are locked into their plan for a year. Insurance contracts with hospitals are not necessarily on the same timeline as your \u201cplan year.\u201d<\/p>\n Certain life events<\/a>, such as getting married, having a baby, or losing a job, can qualify you to change insurance outside of your annual open enrollment period, but your doctors\u2019 dropping out of an insurance network is not a qualifying life event.<\/p>\n 5. Doctor-shopping can be time-consuming.<\/strong><\/strong><\/strong><\/p>\n If the split between your insurance company and hospital looks permanent, you might consider finding a new slate of doctors and other providers who are in-network with your plan. Where to start? Your insurance plan likely has an online tool to search for in-network providers near you.\u00a0<\/p>\n But know that making a switch could mean waiting to establish yourself as a patient with a new doctor and, in some cases, traveling a fair distance.<\/p>\n 6. It\u2019s worth holding on to your receipts.<\/strong><\/p>\n Even if your insurance and hospital don\u2019t strike a deal before their contract expires, there\u2019s a decent chance they will still make a new agreement.<\/p>\n Some patients decide to put off appointments while they wait. Others keep their appointments and pay out-of-pocket. Hold on to your receipts if you do. When insurers and hospitals make up, the deals often are backdated, so the appointments you paid for out-of-pocket could be covered after all.<\/p>\n End of an Ordeal<\/strong><\/strong><\/p>\n Three months after the contract between Wingler\u2019s insurance company and the hospital lapsed, the sides announced they had reached a new agreement. Wingler joined the throng of patients scheduling appointments they\u2019d delayed during the ordeal.<\/p>\n In a statement, Jim Turner, a spokesperson for Anthem\u2019s parent company, Elevance Health, wrote, \u201cWe approach negotiations with a focus on fairness, transparency, and respect for everyone impacted.\u201d<\/p>\n Maze from MU Health Care said: \u201cWe understand how important timely access to pediatric specialty care is for families, and we\u2019re truly sorry for the frustration some parents have experienced scheduling appointments following the resolution of our Anthem contract negotiations.\u201d<\/p>\n Wingler was happy her family could see their providers again, but her relief was tempered by a resolve not to be caught in the same position again.<\/p>\n \u201cI think we will be a little more studious when open enrollment comes around,\u201d Wingler said. \u201cWe\u2019d never really bothered to look at our out-of-pocket coverage before because we didn\u2019t need it.\u201d<\/p>\n Health Care Helpline helps you navigate the health system hurdles between you and good care. Send us your tricky question and we may tap a policy sleuth to puzzle it out. <\/em>Share your story<\/em><\/a>. The crowdsourced project is a joint production of NPR and KFF Health News.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n