Doctor drops out of HMO

[KIP KRAUS]

It seems that I’ve seen this discussed before, but can’t find the thread. If your doctor stops participating in the HMO you are in does this result in a qualifying event? Can you change to another HMO that the doctor participates in, or do you have to find another doctor and wait until open enrollment to make a plan change?

[SLuskin]

You have to choose another doctor. The only way that you can change your health plan would be if an entire category of doctors drops the plan.

That happened to some of my Palm Beach county clients. It seems that all the ob-gyns dropped out of the Blues HMO, so we allowed those people to elect the PPO midyear. Also, the Blues just dropped 2 hospitals there, and we are waiting to see what some of the choices might me.

[KIP KRAUS]

Thanks SLuskin, that's what I thought.