Last winter, Amber Wingler began receiving more and more urgent messages from her local hospital in Columbia, Missouri, telling her her family’s health care could soon be cut off.
MU Health Care, where most of her family’s doctors work, is embroiled in a contract dispute with Wingler’s health insurer, Anthem. Existing contracts are set to expire.
Then, on March 31, Wingler received an email informing her that Anthem was discontinuing the hospital from its network the next day. It embarrassed her.
“I know they negotiate contracts all the time, but the bureaucracy didn’t seem to affect us. We’ve never been pushed out of network like that before,” she said.
The timing was terrible.
Question: When a Missouri mother’s health insurance company couldn’t reach an agreement with her hospital, most of her doctors were suddenly out of network. She wondered how she would get coverage for her child’s care or find a new doctor. “For a family of five… where to start?”
— Amber Wingler, 42, Columbia, Missouri
Wingler’s 8-year-old daughter, Cora, suffered from an unexplained intestinal condition. From gastroenterology to occupational therapy, waiting lists to see a variety of pediatric specialists for a diagnosis can be long, ranging from several weeks to more than a year.
(MU Health Care spokesman Eric Maze said in a statement that the health care system is working to ensure children with the most urgent needs are seen as quickly as possible.)
Suddenly Cora’s specialist visits were out of network. If it was a few hundred dollars each, the out-of-pocket costs would have added up quickly. The in-network pediatricians Wingler found were all located in St. Louis and Kansas City, more than 120 miles away.
So Wingler postponed her daughter’s appointment for several months while she wondered what to do.
Contract disputes are common across the country, with more than 650 hospitals in open disputes with insurers as of 2021. Such contract disputes could become more common as hospitals prepare to cut about $1 trillion in federal health care spending under a bill signed by President Donald Trump in July.
Patients caught up in contract disputes have few options. “There’s an old African proverb that says when two elephants fight, the grass gets trampled. Unfortunately, in these situations, patients often end up being the grass,” said Caitlin Donovan, senior director of the Patient Advocate Foundation, a nonprofit organization that helps people who struggle to access health care.
If you’re feeling crushed by a contract dispute between your hospital and your insurance company, here’s 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 health care providers to set the rates they will pay for various services. If an agreement is reached, the hospital and most of the providers who work there become part of the insurance company’s network.
Most patients prefer “in-network” providers because their insurance pays some, most, or all of their bills, which can run into hundreds or thousands of dollars. If you see an out-of-network provider, you might want to take a look at the full tab.
If you decide to continue seeing a familiar doctor even if he or she is out of network, ask about cash discounts and the hospital’s financial assistance programs.
2. The rift between hospitals and insurers is often repaired.
At the Brown University Health Policy Institute Jason Buxbaum He said he surveyed 3,714 non-federal hospitals across the United States and found that about 18% of them had open disputes with their insurers between June 2021 and May 2025.
About half of those hospitals eventually dropped out of the insurance company’s network, according to Buxbaum’s preliminary data. But most of these breakups are ultimately resolved within a month or two, he added. This allows your doctor to rejoin the network even after the split.
3. You may be able to get an exception to lower your costs.
specific patient serious or complex condition You may be eligible for an extension of your in-network coverage, called continuity of care. You can contact your insurance company to request an extension, but the process may take a long time. Some hospitals have resources available to help patients apply for that extension.
Wingler spent hours making phone calls, filling out forms and sending faxes for her daughter. But she said she doesn’t have the time or energy to do that for her entire family.
“My son was receiving physical therapy.” she said “But I’m sorry, just do the exercise you’re already doing. I’m not fighting to get your insurance money when I’m already fighting for your sister, too.”
Even if you’re dealing with a medical emergency, here’s what’s worth noting: For most emergency services, hospitals Can’t charge patients more than in-network rates
4. You may have to wait to change insurance companies.
You may also consider switching to an insurance company that covers your preferred doctor. But a word of caution: Many people who choose an insurance plan during annual open enrollment are locked into that plan for a year. Your insurance contract with the hospital does not necessarily have to be on the same schedule as your “plan year.”
specific life eventsYou can change your plan outside of the annual open enrollment period due to circumstances such as marriage, having a baby, or losing a job, but having your doctor leave your plan’s network is not a qualifying life event.
5. Doctor shopping can be time consuming.
If the separation between your insurance company and the hospital seems permanent, you may want to consider finding new doctors and other providers that are within your plan and network. Where should I start? Your insurance plan likely has an online tool that allows you to search for in-network providers near you.
However, please be aware that making the switch may mean waiting to become established as a patient with a new doctor or, in some cases, traveling a significant distance.
6. It is a good idea to keep your receipts.
Even if your insurance and the hospital do not reach an agreement before your contract expires, they will likely sign a new contract.
Some patients decide to postpone their appointment while they wait. Others keep their promises and pay out of pocket. If so, keep your receipt. When insurance companies and hospitals reach agreements, deals are often backdated, so appointments you paid for out of pocket may end up being covered.
end of ordeal
Three months after the contract between Wingler’s insurer and the hospital expired, the two sides announced they had reached a new agreement. Wingler joined the throngs of patients booking appointments they had postponed during the ordeal.
“We approach negotiations with a focus on fairness, transparency, and respect for all affected,” Jim Turner, a spokesman for Elevance Health, Anthem’s parent company, wrote in a statement.
MU Health Care’s Maze said, “We understand how important timely access to pediatric specialty care is for families. We sincerely apologize for the frustration some parents experienced following the resolution of Anthem contract negotiations.”
Wingler was glad her family could see their health care providers again, but her relief was tempered by a determination to never be put in the same position again.
“I think we’ll work a little harder as open enrollment approaches,” Wingler said. “Before, we never bothered to look at out-of-pocket costs because we didn’t need them.”
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