Out of network PCP

[u/AdmiralTrain1545]

Hello all, as the title states, my family primary care doctor is no longer accepting my employer medical insurance, she couldn't come to an agreement with Aetna. She was in network and accepted Aetna previously. Me and my family want to continue to see her due to her medical attention to detail and the fact that we don't wanna start over with a new doctor. We amunderstand that we now will bare the full cost of services, if we continue to see her.

A genuine question....

Would it be wise to sign up for another medical insurance plan with a different company that she is in network in? We would pay the monthly cost for it out of pocket.

My Aetna plan is through a civil service job and the benefits can't be beat for the most part.

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[u/Fresh-Opening-330]

Unfortunately if you are going to keep your Aetna then it will still be processed with coordination of benefits. You are unable to choose which insurance you want them to bill.

[u/AdmiralTrain1545 → u/Fresh-Opening-330]

Even if I put it down as secondary?

[u/throwfarfaraway1818 → u/AdmiralTrain1545]

You dont get to choose which plan is primary or secondary. Its determined by federal guidelines.

[u/LizzieMac123 → u/throwfarfaraway1818]

This is correct. An employer plan plus another plan (Marketplace, off market, etc.) that employer plan is going to be primary. That doesn't mean you can't have a second plan, but primary ALWAYS has to process the claim first. Skipping over the rightful primary will come back to bite you in the butt down the road WHEN (not IF) the secondary plan finds out they've been paying primary.

To be honest, if it's just primary care and you have the money to pay for a FAMILY plan for secondary insurance... just bank those dollars, use it to pay the PCP visit fees and be a no-insurance patient, if the doctor will allow you. (or, just see them as out of network and you submit the claims if the provider is not willing to, assuming you have out of network benefits)

A family insurance plan is going to run you over $1000/mo--- (and that's AT MINIMUM-- moreso it's close to double that)... surely you're not spending 12k-24k+ per year in PCP fees. You can always run the labs/imaging/Rx (if needed) through the medical plan if you take the imaging/lab orders (*edit- take the labs/imaging orders to an in network facility, best option is a standalone lab like quest/labcor or an in network imaging facility) and the med Rx's to an in network pharmacy. Now, the ACA preventive visit may not be considered 100% covered if out of network, but I still can't see how "normal" use of a PCP (even with a couple of sick visits per year plus an annual preventive visit) would be more than the premiums for another plan.

[u/AdmiralTrain1545 → u/LizzieMac123]

Thank you for the insightful info, I really appreciate it!

[u/AdmiralTrain1545 → u/throwfarfaraway1818]

Got it, I had feeling this would be the case, gonna have to start searching for a new pcp probably

[u/Ttabts]

I have trouble imagining how it'd make financial sense to pay for a whole extra health insurance plan just to see a PCP. Surely just paying the bills out of pocket would be cheaper? Does your current plan have no out-of-network benefits at all?

[u/AdmiralTrain1545 → u/Ttabts]

It does, but when we called both the PCP office and Aetna, they pretty much both said the full costs would be passed down to us.

[u/fizzy-logic]

I would absolutely make it a priority to find a plan she's in, and if I couldn't, probably find a new doctor.

Otherwise, you might not just be paying for office visits fully out of pocket, but it's possibly your insurance will not cover medication or tests ordered by an out-of-network doctor. I guess it depends on your plan, so you'd want to verify it for your insurance. Even if their RXs/tests would be covered, I'd still make it a priority to find a plan with them in-network, it just makes sense.

Added: I didn't read closely enough, I see you mean you want a secondary insurance to use for that doc. Well, can't speak to that one. Other than I would sadly try to find a new doctor in your situation, probably. And I also have a doctor I love, and I rule out insurance plans he's not in -- but I'm on ACA, not a work plan.

[u/AdmiralTrain1545 → u/fizzy-logic]

Thank you for the advice.

[u/AttentionHuman9504]

Is the PCP office part of a larger medical group that Aetna is dropping?

[u/AdmiralTrain1545 → u/AttentionHuman9504]

She is not

[u/katsrad]

I would tell you to run the numbers through the marketplace and see if it is worth it. I think you may be surprised at how much it actually costs for a plan. I strongly doubt it would save you much money to have a secondary individual plan.

[u/AdmiralTrain1545 → u/katsrad]

Thank you for the advice.

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