Healthcare Reform

Does the health reform law limit my choice of providers?

A Answers (2)

  • The health care reform law includes certain requirements, called patient protections, in relation to choice of providers. The requirements are similar to many state laws in effect today, and the rules apply to non-grandfathered plans that utilize a network of providers.

    If the plan requires or provides for the designation of a primary care provider (PCP), the participant must be able to designate any participating PCP who is available to accept the patient. The plan may designate a PCP for a participant who enrolls without choosing a PCP.

    For a child, the plan must allow a participating pediatrician to be designated as the PCP.

    A plan cannot require pre-authorization or a referral to access an OB/GYN provider. If a participant visits a participating OB/GYN provider, the care received must be covered as though it were provided by the PCP.

    For more information on health care reform and how it affects you, go to or

    This communication is not intended as legal or tax advice. Please contact a competent legal or tax professional for personal advice on eligibility, tax treatment and restrictions. Federal and state laws and regulations are subject to change.

  • A , Nursing, answered

    Healthcare providers, like hospitals and physicians, are NOT on all health plans.  Each health plan works with providers to determine their own network of hospitals and physicians.  Therefore, it is important to understand which hospitals and physicians are connected with a health insurance plan you may be considering.  This is also something that changes from year to year since the insurance company will sign new contracts with providers each year.   As you renew your health insurance each year, check the designated network of providers before making your final decision.
Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.
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