What to Do If Your Doctor Leaves Your Health Insurance Network Mid-Year in 2026: The 90-Day Continuity of Care Right, SEP Exceptions, and How to Keep Seeing Your Provider

You open the mail (or an app alert) and there it is: your insurer or your doctor's office says the two are parting ways at the end of the month. The oncologist you've been seeing for chemo, the OB-GYN four months into your pregnancy, the surgeon who's supposed to do your follow-up next week — suddenly out of network.

Contract disputes between insurers and hospital systems have become a regular headline in 2026. When one blows up, patients get caught in the middle. The good news: federal law gives many people a 90-day window to keep seeing the same provider at in-network prices. The bad news: the rule doesn't cover everyone, and you have to actually request it in writing. Here's exactly how the right works, who qualifies, and what to do if you don't.

The No Surprises Act, effective for plan years beginning on or after January 1, 2022, created a federal "continuity of care" protection when an in-network provider or facility ends its contract with your plan. If you are a "continuing care patient," you can elect to keep seeing that provider at the same in-network cost sharing for up to 90 days from the date the plan notifies you of the network change — or until you're no longer a continuing care patient, whichever comes first.

During that transitional window, three things are true:

• Your copay, coinsurance, and deductible for that provider stay at in-network levels.
• Your plan pays the provider under the same terms and conditions as if the contract had not ended.
• The provider must accept the plan's in-network payment as payment in full for the covered items and services during the window.

The rule doesn't protect general access to a preferred doctor. It protects specific ongoing treatment relationships. You qualify if you're in one of these categories on the date of the network change:

• You are undergoing a course of treatment for a serious and complex condition — for example, active chemotherapy or radiation, complex behavioral-health treatment, a rare or life-threatening disease under active management by that provider.
• You are undergoing a course of institutional or inpatient care — for example, a hospitalization, inpatient rehab, or skilled nursing stay under way.
• You are scheduled to undergo a non-elective surgery with that provider, or you are within the standard post-operative follow-up period.
• You are pregnant and undergoing a course of treatment for the pregnancy. This does not require a specific trimester — if you are pregnant and receiving OB care from the provider, you qualify.
• You are receiving treatment for a terminal illness.

Not on the list: an annual physical, a new referral you were about to book, a routine dermatology check, a preventive screening that could just as easily be done by another in-network provider. The federal right protects continuing care, not first-time access.

Log in to your plan portal and look for a "network change" notice or letter. If you can't find one, call member services and ask for the notice to be resent, along with the exact effective date of the termination and confirmation that you're identified as a continuing care patient. Save the notice — the date on it is the day the 90-day clock begins.

1. Ask, on the phone: "When did your plan send me formal notice that [provider] is leaving the network, and what is the exact effective date of termination?"
2. Ask, in writing (email or portal message): "Please confirm that I am eligible for continuity of care under the No Surprises Act, and provide the form or process for requesting it."
3. Save the reply. This is your paper trail if a claim is later denied.

Most insurers require the election in writing. Some have a specific form buried in the portal; others accept a plain letter. Include:

• Your name, member ID, and date of birth.
• The provider's name and NPI (national provider identifier).
• The clinical basis: your diagnosis and why you meet one of the continuing care patient categories.
• Your election of the 90-day continuity of care period under the No Surprises Act.
• A request that the insurer confirm the approval, the effective dates, and the covered services in writing.

Ask your provider's billing office to send a supporting letter documenting your active treatment plan — a one-paragraph note from the physician often speeds things up. Send everything by a method you can prove: certified mail, a portal message with a timestamp, or an email you can point to later.

Continuity of care preserves in-network cost sharing, but "in-network" still means you owe copays, coinsurance, and any remaining deductible. Before you make treatment decisions, run the math. What are your out-of-pocket costs likely to be for the rest of the plan year if the transitional period covers your care? What if it doesn't — can you afford out-of-network prices for even a few visits?

Our Plan Cost Calculator can help you estimate your total out-of-pocket exposure under different scenarios, and the Procedure Cost Estimator can price specific upcoming visits or procedures. If a surgery or major treatment is planned, our deductible explainer is a quick primer on how your deductible and out-of-pocket max interact.

Several states layer longer or broader continuity of care rules on top of the federal minimum. A few examples:

• California extends continuity of care to a range of ongoing conditions and, for pregnancy, allows continued care through the postpartum period.
• New York permits up to 60 additional days beyond the federal window in certain cases, and up to the postpartum period for pregnant enrollees.
• Texas, New Jersey, and several others extend transitional care to specific chronic conditions, mental health treatment, or terminal illness beyond 90 days.

Fully insured individual and small-group plans in your state usually follow both federal and state rules, and the more generous of the two applies. Self-funded employer plans (large employers, most Fortune 500s) usually follow only the federal rule. Ask your HR department or benefits admin to confirm which category your plan falls into.

Most people caught in a network change aren't in active complex treatment — they just liked their doctor. The federal right won't help there. Two things do:

• Ask your insurer for a "single case agreement." This is a one-off contract that lets you continue seeing the out-of-network provider at in-network rates when no comparable in-network option is available. Approvals are discretionary, but insurers are more likely to say yes when the alternative is a costly new-patient workup with someone else.
• Use the insurer's updated provider directory carefully. Directories are notorious for being out of date. Call any prospective new provider directly and confirm they are (a) taking new patients and (b) still contracted with your specific plan — not just the parent insurer. Ask about the first-appointment lead time so you can bridge care safely.

Usually no. Losing access to a specific in-network provider is not a qualifying life event for a marketplace Special Enrollment Period on HealthCare.gov or state exchanges. You are generally locked in until the next Open Enrollment window (November 1, 2026 through January 15, 2027 for 2027 coverage).

A few narrow exceptions exist:

• If the marketplace determines the plan is no longer meeting network adequacy standards in your area, an SEP may be triggered. This is rare and requires a state or CMS finding, not a member complaint.
• If you also have a separate qualifying life event — a move to a new county, a marriage, a birth, loss of other coverage — you can enroll in a different plan for a reason unrelated to the network change.
• If you're on Medicare Advantage, CMS periodically grants an SEP when a plan has a "significant network change" (usually defined as a large involuntary loss of providers). Call 1-800-MEDICARE and ask if a network-change SEP is available in your county for your plan.

For everyone else, the practical path is to use the 90-day continuity window, plan a bridge to an in-network alternative, and pencil a note into your calendar for Open Enrollment.

Sometimes claims from the transitional period get processed as out-of-network anyway — automation doesn't always catch the manual override. If that happens:

1. Call member services with the claim number and the date of your continuity of care approval. Ask them to reprocess.
2. If reprocessing fails, file a formal internal appeal within your plan's deadline (usually 180 days from denial). Include your approval letter and clinical documentation.
3. If the internal appeal is denied, request an external review. Most ACA-compliant plans must offer independent external review, and continuity of care disputes are eligible.
4. If you believe your plan violated the No Surprises Act, you can also file a complaint with the federal No Surprises Help Desk at 1-800-985-3059 or your state department of insurance.

For a step-by-step walkthrough of the internal-then-external appeal process, see our companion guide, how to appeal a health insurance claim denial.

Scenario 1: Pregnant, 22 weeks, OB leaves the network

You almost certainly qualify. Submit the written election, get insurer confirmation, and continue prenatal, delivery, and (if your state extends it) postpartum care under in-network rates. If you're in a state with a full-pregnancy continuity rule, the coverage may last well beyond the federal 90 days.

Scenario 2: Post-op follow-up in month 2

You qualify. The federal rule specifically protects the standard post-surgical follow-up period. Even if the surgery itself was already covered, the follow-up visits should continue at in-network cost sharing during the 90-day window.

Scenario 3: You just like your primary care doctor

You likely don't qualify under the federal rule. Options: request a single case agreement (long shot for routine primary care), find a new in-network PCP quickly, and note the change on your calendar so you can consider a different plan during Open Enrollment.

Scenario 4: Medicare Advantage plan drops your specialist

The No Surprises Act 90-day rule doesn't apply. Ask about CMS's Medicare Advantage continuity provisions. If a "significant network change" SEP is granted for your plan, you may be able to move to Original Medicare with a supplemental plan and a standalone Part D plan — run the math on your total costs first.

A mid-year network change is stressful, but for many patients it isn't a coverage cliff. If you're in active complex care, pregnant, in post-op recovery, or under treatment for a serious illness, federal law gives you 90 days — and sometimes more — to keep the same provider at the same cost. You just have to know the right exists, and put your election in writing.

Everyone else has more limited options, but the practical playbook is the same: get the notice in writing, price out your alternatives, ask for a single case agreement if a specific relationship matters, and calendar Open Enrollment. Contract disputes get resolved more often than not, and your provider may be back in-network before you know it.

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