The past winter, Amber Wingler began receiving a series of increasingly urgent messages from the local hospital in Columbia, Missouri, informing her that her family’s medical care could be affected soon.
MU Health Care, where most of the doctors her family uses practice, was embroiled in a contractual dispute with Anthem, Wingler’s health insurer. The existing contract was about to expire.
Then, on March 31, she received an email alerting her that the next day the hospital would no longer be in Anthem’s network.
The news left her stunned.
“I know they negotiate contracts all the time… but it seemed like a simple bureaucratic process that wouldn’t affect us. I had never been excluded from an insurer’s network like that before,” she remarked. The timing could not have been worse.
“The Consultation: When a Missouri mother’s health insurer couldn’t reach an agreement with her hospital, most of her doctors were suddenly out of network. She wondered how she would get her children’s medical care covered or how she would find new doctors. ‘For a family of five… where do we start?'” – Amber Wingler, 42, from Columbia, Missouri.
Wingler’s 8-year-old daughter, Cora, had been experiencing unexplained intestinal issues. The waitlists to see various pediatric specialists and get a diagnosis, from gastroenterology to occupational therapy, were long: ranging from weeks to over a year.
(Spokesperson for MU Health Care, Eric Maze, stated in a release that the health system works to ensure that children with the most urgent needs are seen as soon as possible).
Suddenly, Cora’s appointments with specialists were out of her insurance network. At several hundred dollars each, the cost would have quickly skyrocketed. The only other pediatric specialists within the network that Wingler found were in St. Louis and Kansas City, both over 120 miles away.
So Wingler postponed her daughter’s medical appointments for months while she tried to figure out what to do.
Across the country, contractual disputes are common, with over 650 hospitals involved in public conflicts with insurers since 2021.
And they could become even more frequent as hospitals prepare for approximately $1 billion in federal healthcare spending cuts, as stipulated by President Donald Trump’s flagship law, enacted in July.
Patients caught in a contractual dispute have few viable options.
“There is an old African proverb that says: when two elephants fight, the grass gets trampled. And, unfortunately, in these situations, often the patients are the grass,” stated Caitlin Donovan, director of the Patient Advocate Foundation, a non-profit organization that helps people struggling to access healthcare.
If you feel crushed under a contractual dispute between a hospital and your insurer, here’s what you need to know to protect yourself financially:
1. “Out of network” means you will likely pay more.
Insurers negotiate contracts with hospitals and other medical providers to establish the rates they will pay for various services. When they reach an agreement, the hospital and most providers working there become part of the insurer’s network.
Most patients prefer to see “in-network” providers because their insurance covers part, most, or even all of the bill, which could amount to hundreds or thousands of dollars. If you see an out-of-network provider, you may have to pay the full bill.
If you decide to stick with your regular doctors even if they are out of network, you can inquire about the possibility of getting a cash payment discount and the hospital’s financial assistance program.
2. Disputes between hospitals and insurers are often resolved.
Jason Buxbaum, a health policy researcher at Brown University, examined 3,714 non-federal hospitals in the United States and found that between June 2021 and May 2025, 18% of them had a public dispute with a health insurance company.
About half of those hospitals eventually withdrew from the insurer’s network, according to Buxbaum’s preliminary data. However, most of these breakups are resolved in one or two months. Therefore, it is very likely that your doctors will rejoin the network, even after a separation.
3. You may qualify for an extension to reduce costs.
Certain patients with serious or complex conditions may qualify for an extension of coverage within the network, called continuity of care.
You can request this extension by calling your insurer, but the process can be lengthy. Some hospitals have set up resources to help patients apply.
Wingler went through all that ordeal for her daughter: hours on the phone, filling out forms, and sending faxes.
But she said she didn’t have the time or energy to do it for all members of her family.
“My son was in physical therapy,” she said. “But I’m sorry, son, you keep doing the exercises you need to do. I’m not going to fight to get you covered too, when I’m already fighting for your sister,” she told herself.
It is also important to consider if it is a medical emergency: in most emergency services, hospitals cannot charge patients more than the rates in their network.
4. You may have to wait to change insurers.
You may be thinking of switching to an insurer that covers your favorite doctors. But keep in mind that many people who choose their health plans during the annual open enrollment period are tied to their plan for a year. Contracts between insurers and hospitals do not necessarily coincide with the year of your plan.
Certain life events, such as getting married, having a child, or losing your job, may allow you to change insurance outside the annual open enrollment period, but your doctors leaving your insurer’s network is not considered a life event that allows you to do so.
5. Finding a new doctor can take a long time.
If the rift between your insurer and the hospital seems final, you may consider looking for a new list of doctors and other providers who are in your plan’s network. Where to start? Your plan probably has an online tool to search for in-network providers near where you live.
But keep in mind that changing doctors could mean waiting to establish yourself as a new patient, and in some cases, having to travel further.
6. It’s worth keeping the receipts.
Even if your insurance and the hospital do not reach an agreement before their contract expires, there is a chance they will reach a new deal.
Some patients decide to postpone their appointments while they wait. Others keep their appointments and pay out of pocket. If that’s the case, keep the receipts. When insurers and hospitals reach an agreement, it usually applies retroactively, so the appointments you paid for out of pocket could be covered after all.
End of an ordeal
Three months after the contract expired between Wingler’s insurer and the hospital, both parties announced a new agreement. Wingler joined the crowd of patients who scheduled the appointments they had postponed during the crisis.
In a statement, Jim Turner, spokesperson for Elevance Health, Anthem’s parent company, wrote: “We approached the negotiations focused on fairness, transparency, and respect for all affected.”
Maze, from MU Health Care, said: “We understand the importance of timely access to specialized pediatric care for families and deeply regret the frustration some parents have experienced in trying to schedule appointments following the resolution of our contract negotiations with Anthem.”
Wingler was relieved that her family could see their doctors again, but her relief was tempered by the determination not to find herself in the same situation again.
“I think we’ll be a little more cautious when open enrollment comes around,” Wingler said. “We had never worried about reviewing our out-of-pocket coverage because we didn’t need it.”
This rewritten article retains the key points and information from the original post while providing a fresh take on the topic.
