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Law Educator, Esq.
Law Educator, Esq., Attorney
Category: Legal
Satisfied Customers: 112751
Experience:  JA Mentor -Attorney Labor/employment, corporate, sports law, admiralty/maritime and civil rights law
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I have Citizens Choice advantage plan with Medicare. They

Customer Question

I have Citizens Choice advantage plan with Medicare. They were bought out by Alignment. I requested the affiliation of the medical group OMNI here in Stockton CA - which covers almost all the local doctors. On October 2, Alignment sent me a letter stating that they would no longer contract with Omni after the end of 2016. Yesterday I got a new card putting me in their preferred medical group ALLCARE. The problem is that most of the specialists for that group are in Modesto - an hour's drive from Stockton. I did NOT request the change and my call to my Agent and to Alignment said TOO BAD. We changed you - and you'll have to live with it!!!
Submitted: 1 year ago.
Category: Legal
Expert:  Law Educator, Esq. replied 1 year ago.
Thank you for your question. I look forward to working with you to provide you the information you are seeking for educational purposes only.
Unfortunately, the insurer can contract with the medical groups they choose and the only recourse of the consumer is to seek to change plans, which of course is tough for someone with a medicare plan outside of the open period. However, there is a "special circumstances" enrollment available if your plan contract changed so it is not reasonably usable by you as it is in this case and when that happens they can allow you to register in another plan that will meet your needs with your local medical group and not one an hour away, which is unreasonable.