You have the right to choose the doctor you want from your health plan’s provider network. You also can use an out-of-network emergency room without penalty.

  • You pick your doctor: You can choose any available primary care provider in your insurance plan’s network. You can choose any available network pediatrician as your child’s primary care doctor.

  • No referrals needed for OB-GYN services: You don’t need to get a referral from a primary care provider before you can get obstetrical or gynecological (OB-GYN) care from a specialist.

  • Access to out-of-network emergency room services: Insurance plans can’t require higher copayments or coinsurance if you get emergency care from an out-of-network hospital. They also can’t require you to get prior approval before getting emergency room services from a provider or hospital outside your plan’s network.

Does this apply to my plan?

It depends. These rights don’t apply to health plans created or bought before March 23, 2010, which are known as grandfathered plans. Check your plan’s materials or ask your employer or benefits administrator to find out if your health plan is grandfathered.