Is your cancer team in network?
Cancer care is not delivered by one doctor. It is delivered by an oncologist, a hospital, an infusion suite, a pathology lab, an imaging center, and often an anaesthetist — and every one of them holds its own contract with your plan. People confirm the oncologist, switch plans, and then get an out-of-network bill from the lab that read their biopsy.
The plan’s online directory is not good enough on its own
Provider directories are frequently out of date, and being listed in one does not entitle you to in-network pricing. The answer that holds up is the one you get from the provider’s billing office, with a date and a name attached. Check both, and record both — if they disagree, the screenshot of the directory is useful evidence later.
Your care team checklist
List everyone who bills for your care, then check each one twice — once in the plan’s directory, and once by calling the office. Saved on this device only.
Everyone on your list has been confirmed by phone.
Network status is per address, not per doctor.
Worth re-checking each autumn — contracts renew in January.
Directory: Not checkedPhone call: Not checkedNetwork status is per address, not per doctor.
Worth re-checking each autumn — contracts renew in January.
Directory: Not checkedPhone call: Not checkedNetwork status is per address, not per doctor.
Worth re-checking each autumn — contracts renew in January.
Directory: Not checkedPhone call: Not checked
What to say when you call
“I’m checking coverage before I enroll. Are you contracted as an in-network provider with [exact plan name], at [this address], for the [year] plan year? And are the other doctors in your practice contracted too?”
- Ask the billing office, not the front desk. “We take Medicare” is not the same answer as “we are contracted with that Medicare Advantage plan”.
- Name the plan exactly. Insurers run several plans with near-identical names, and a practice may be in one and not another.
- Ask about next year specifically if you are calling during open enrollment. Contracts turn over on 1 January.
- Write down who you spoke to and when. If a bill goes wrong later, that note is your evidence.
If you have Original Medicare
There is no network. Any provider in the country who accepts Medicare will see you, which is the main reason people getting a second opinion at a distant cancer center stay with it. The thing to confirm instead is whether a provider “accepts assignment” — if they do not, they may charge you up to 15% above the Medicare-approved amount.
Look up a provider on Medicare Care CompareIf your doctor leaves the network mid-year
Ask the plan about continuity of care. Plans are generally expected to let someone in active treatment finish a course of care with their existing doctor for a transitional period. Get the arrangement in writing before the next appointment.
If just one of your doctors leaves the network — rather than a large group — you may not automatically qualify. Call 1-800-MEDICARE and ask them to consider a Special Enrollment Period for your situation. Medicare decides these case by case.
Next: check your medicines or put your plans side by side.
Talk it through with a Medicare counselor
Every state has a State Health Insurance Assistance Program — trained counselors who sit down with you one-on-one, go through your own medications and doctors, and help you work out what your options actually cost. It is free, it is confidential, and they earn nothing whichever plan you choose. If you only do one thing on this page, do this one.