School, college and other closings for Monday

MPR News helps you turn down the noise and build shared understanding. Turn up your support for this public resource and keep trusted journalism accessible to all. 

Turn Up Your Support

When a Missouri mom's health insurance company couldn't come to an agreement with her hospital, most of her doctors were suddenly out of network. She wondered how she would get her kids' care covered or find new doctors. "For a family of five, … where do we even start?"

Amber Wingler, 42, from Columbia, Missouri

Last winter, Amber Wingler started getting a series of increasingly urgent messages from her local hospital in Columbia, Missouri, letting her know her family's health care might soon be upended.

MU Health Care, where most of her family's doctors work, was mired in a contract dispute with Wingler's insurance company, Anthem. The existing contract was set to expire.

Then on March 31, Wingler received an email alerting her that the next day, Anthem was dropping the hospital from its network. It left her reeling.

"I know that they go through contract negotiations all the time, … but it just seemed like bureaucracy that wasn't going to affect us. I'd never been pushed out-of-network like that before," she said. 

Wingler's 8-year-old daughter, Cora, had been having unexplained troubles with her gut. Waitlists to see various pediatric specialists to get a diagnosis, from gastroenterology to occupational therapy, were long — ranging from weeks to more than a year.

(In a statement, MU Health Care spokesperson Eric Maze said the health system works to make sure children with the most urgent needs are seen as quickly as possible.)

Suddenly, the specialist visits for Cora were out-of-network. At a few hundred bucks a piece, the out-of-pocket cost would have added up fast. The only other in-network pediatric specialists Wingler found were in St. Louis and Kansas City, both more than 120 miles away.

So Wingler delayed her daughter's appointments for months while she tried to figure out what to do.

Nationwide, contract disputes are common with more than 650 hospitals having a public spat with an insurer since 2021. They could

 as hospitals brace for about $1 trillion in cuts to federal health care spending prescribed by President Donald Trump's

Patients caught in a contract dispute have few good options. 

"There's that old African proverb: that when two elephants fight, the grass gets trampled. And unfortunately, in these situations, oftentimes patients are grass," said Caitlin Donovan, a senior director at the Patient Advocate Foundation, a nonprofit that helps people access health care.

If you're feeling trampled by a contract dispute between a hospital and your insurer, here is what you need to know to protect yourself financially:

1. ‘Out-of-network’ means you’ll likely pay more

Insurance companies negotiate contracts with hospitals and other medical providers to set the rates they will pay for various services. When they reach an agreement, the hospital and most of the providers who work there become part of the insurance company's network.

Most patients prefer to see providers who are "in-network" because their insurance picks up some, most, or even all of the bill, which could be hundreds or even thousands of dollars. If you see an out-of-network provider, you could be on the hook for the whole tab.

If you decide to stick with your familiar doctors even though they're out of network, consider asking about getting a cash discount and about the hospital's financial assistance program.

2. Rifts between hospitals and insurers often get repaired

When Brown University health policy researcher

 examined 3,714 nonfederal hospitals across the U.S., he said, he found that about 18 percent of them had a public dispute with an insurance company sometime from June 2021 to May 2025.

About half of those hospitals ultimately dropped out of the insurance company's network, according to Buxbaum's preliminary data. But most of those breakups ultimately get resolved within a month or two, he added. So your doctors very well could end up back in-network, even after a split.

3. You might qualify for an exception to keep costs lower

 might qualify for an extension of in-network coverage, called continuity of care. You can apply for that extension by contacting your insurer, but be aware it could be a lengthy process. Some hospitals even set up resources to help patients apply for that extension.

Wingler ran that gauntlet for her daughter, spending hours on the phone, filling out forms and sending faxes. But she said she didn't have the time or energy to do that for everyone in her family.

"My son was going through physical therapy," she said. "But I'm sorry, dude, like, just do your exercises that you already have. I'm not fighting to get you coverage too when I'm already fighting for your sister."

Also worth noting, if you're dealing with a medical emergency, for most emergency services, hospitals

4. Switching your insurance carrier may need to wait

You might be thinking of switching to an insurer that does cover your favorite doctors. But be aware: Many people who choose their insurance plans during an annual open enrollment period are locked into their plan for a year. Insurance contracts with hospitals are not necessarily on the same timeline as your "plan year."

 such as getting married, having a baby, or losing a job can qualify you to change insurance outside of your annual open enrollment period, but your doctors' dropping out of an insurance network is not a qualifying life event.

If the split between your insurance company and hospital looks permanent, you may want to consider finding a new slate of doctors and other providers who are in-network with your plan. Where do you start? Your insurance plan likely has an online tool where you can search for in-network providers near you.

But know that making a switch could mean waiting to establish yourself as a patient with a new doctor and, in some cases, traveling a fair distance.

6. It’s worth holding on to your receipts

Even if your insurance and hospital don't strike a deal before their contract expires, there's a decent chance they will still make a new agreement.

Some people decide to put off appointments while they wait. Others keep their appointments and pay out-of-pocket. Hold on to your receipts if you do. When insurers and hospitals make up, the deals often are backdated, so the appointments you paid for out-of-pocket could be covered after all.

Three months after the contract between Wingler's insurance and hospital lapsed, the sides announced they had reached a new deal. Wingler joined the throng of patients scheduling appointments they'd delayed during the ordeal.

In a statement, Jim Turner, a spokesperson for Anthem's parent company, Elevance Health, wrote, "We approach negotiations with a focus on fairness, transparency, and respect for everyone impacted."

Maze from MU Health Care said: "We understand how important timely access to pediatric specialty care is for families, and we're truly sorry for the frustration some parents have experienced scheduling appointments following the resolution of our Anthem contract negotiations."

Wingler was happy her family could see their providers again, but her relief was tempered by a resolve to not be caught in the same position again.

"I think we will be a little more studious when open enrollment comes around," Wingler said. "We'd never really bothered to look at our out-of-pocket coverage before because we didn't need it."

Health Care Helpline helps you navigate the health system hurdles between you and good care. Send us your tricky question and we may tap a policy sleuth to puzzle it out.

. The crowdsourced project is a joint production of NPR and KFF Health News.

 is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at

Health

Politics and Government News

Homepage

Bram Sable-Smith

Author

Patients sometimes find themselves scrambling for affordable care when their insurer and hospital get into a contract dispute. Here are six things to know if that happens to you. 

Out-of-network and on your own? What to do if your insurer drops your doctors

Go Deeper.

Like this?

News you can use in your inbox