Heads-Up! Covered next year? Check directly with provider's office.  (#Sep 26, 2025)

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Call your providers' offices -- doctor, etc. -- to verify that they will accept your specific plan or network next year.

They may not be accepting new patients under a specific plan. May be dropping some plans from certain insurance companies.

More and more providers are no longer accepting new Medicare patients -- or only accepting Supplement plans.

Don't count on websites or other databases.

Many members report being caught this way.

As one member put it: "The out of network providers have to accept the plan or you may have to pay the full ride."

The online databases are not the final word...

- Doctors have multiple affiliations. Especially common with specialists, such as anesthesiologists. One member reported: "Prior to my medical visit, I checked to see if this physician was in network and she was BUT as it turned out, NOT in the location where I went for treatment. I discovered this when I only received a portion of the amount of the reimbursement I expected..."

- Databases have errors -- for example a provider entered under a variation in spelling or different form of the business name.

- Business arrangements in the health industry change from year to year. (From a few years ago... "As of Nov 4, 2022, the Sutter Health website -- including Palo Alto Medical Foundation -- indicates doctors that are accepting new patients under Medicare plans, when the PAMF Registrar's Office says that is not the case. It appears that Sutter negotiations with Medicare have broken down.")

- If a physician, do they charge a monthly or annual "concierge" or "membership" charge? This may not show up on the doctor's website or on list of in-network providers for your plan.  (More info from HPAA members: https://www.hpalumni.org/health-concierge )

Note: Doctors are generally not employees of a not-for-profit health system or hospital where they practice.

Look closely at their website, name badge, or office door and you should see their legal employer -- which is often structured as a partnership that contracts with the health system or hospital. Some examples:

- Doctors working at Sutter Health System facilities in the Bay Area are employees of the 1,600-physician Palo Alto Foundation Medical Group, Inc. "Shareholder eligible after two years. Shareholders enjoy very competitive, production-based income." 

- Similarly, for El Camino Health there is the El Camino Health Medical Network, Inc. El Camino Health also contracts with small partnerships -- such as the 13-physician Urological Surgeons of Northern California, Inc.

- Doctors working for the not-for-profit Kaiser Health Plan and Kaiser Hospital are employees of the 9,900-physician Permanente Medical Group, Inc. "Shareholder Track" with salary and incentives. Some are per-diem.

Call. The only way to be sure is to talk to someone in the admin side of the provider's office.

If possible, see if you can reach the person who spends their workday prying payments out of Medicare, health plans, and insurance companies. (BTW, that person's choice of words or tone of voice can tell you a lot about the health plan or insurance company in question.)

--moderator
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