How do I request a doctor be added to my Medicare Advantage plan?
Answered by 10 licensed agents
You cannot directly “add” a doctor to a Medicare Advantage plan yourself, since provider participation is based on contracts between the doctor and the insurance company. However, you can ask your doctor’s office if they are willing to contract with the plan, and you can also contact the plan to request they reach out to that provider. Keep in mind that network changes are not guaranteed and can take time. If keeping a specific doctor is critical, you may need to consider a plan that already includes them in-network.
Before enrolling in a Medicare Advantage plan make certain your doctors/providers are all in-network. If you see a doctor outside of the contracted network you will likely have higher costs.
Today, start by calling the doctor's office to find out if they are accepting new patients. Ask which insurance plans and companies they accept. After that, check your insurance company’s directory to make sure the doctor is listed.
Please call your Doctor & request that he or she accept the Terms & Conditions of payment from your Insurance Company to which you have a Medicare Advantage plan. Meaning to join their network.
Plans are insured or covered by a Medicare Advantage (HMO, PPO and PFFS) organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
You can contact your Medicare Advantage plan and request that a doctor be considered for the network, but the doctor must agree to contract with the insurance company before they can be added. You can also ask the doctor’s office if they’re willing to begin the credentialing process with the plan.
If your doctor is not currently in your Medicare Advantage plan, you can call your insurance company and ask if they can add that provider to their network. You can also have your doctor’s office contact the plan directly to request participation.
Markets are changing all the time! If you're favorite doctor isn't in your current advantage plan, talk to them! Your agent can also help your carrier and doctor link up to see if there is a way to make it work.
To request that a doctor be added to your plan, you basically contact your insurance company (the one that provides your Medicare Advantage plan) and ask if they can contract with that doctor. You can call the member services number on your insurance card and tell them you want a certain doctor added to the network. They’ll take the doctor’s name and office information and let you know whether they can reach out to the doctor or if they already have a process for this. They can’t guarantee the doctor will join, but they will tell you what steps they can take and what your options are in the meantime.
To clarify, if you are asking how your Dr can be added to the network. You can ask you Dr to reach out to the carrier and complete their contract to become a provider. Your Dr would have to agree to the trend of that contract before becoming a preferred provider.
But if you are asking how to add your Dr to your existing plan, and your Dr is already in-network, you can contact member services and add your Dr. If you need additional clarification, please feel free to contact me. Aurelia Chatman- Your Health Partner
