What Insurance Contract Disputes Mean for Patients

By Amanda Brummitt and Nancy Mace

We’ve all seen the scary headlines — including the most recent one:
“Southwestern Health Resources is out of network with Blue Cross Blue Shield of Texas as of April 1st.”

It’s jarring for patients and frustrating for providers, but these types of disputes between insurers and health systems are becoming increasingly common. So, what’s really going on behind the scenes when two industry giants go head-to-head?

We tapped healthcare strategist Amanda Brummitt to unpack the perspective from hospitals and physician groups, and Nancy Mace, a patient advocate, to help patients understand how to navigate these disruptions.

What Are the Medical Providers Thinking?

Whether it was at the world’s largest hospital system or the biggest private anesthesia practice in Texas, I was part of payer negotiations that happened every three to five years. Most of the time, contracts were finalized quietly and efficiently before the old agreement expired. But sometimes, negotiations went down to the wire — or worse, past the expiration date.

You’d think extending the existing agreement temporarily would be a no-brainer to avoid patient care interruptions. But it’s not that simple. Sometimes, one party is losing money under the current contract. Operational costs, like staffing and supplies, can rise significantly over three years. If reimbursement rates don’t keep up, providers may be delivering care at a financial loss.

It’s a tough place to be. Emotions run high. One side feels squeezed. The other feels blindsided.

From the insurer’s perspective, maintaining a robust network is key to keeping employer clients and members happy. But they also have to manage costs. If they’re overpaying providers, it means higher premiums — and unhappy customers.

On the provider side, health systems and medical groups want to serve as many patients as possible. Signing a contract with an insurer typically means offering discounted rates in exchange for patient volume. But if that volume doesn’t offset the discount — or if costs rise faster than expected — the math stops working.

So what happens? Negotiations stall. Each side tries to gain leverage. And that’s when the letters go out — to patients, employers, and the media.

The official line is that these communications are “required notifications.” But let’s be honest: they’re pressure tactics. They’re designed to rally public support, stir outrage, and push the other party to the table.

Is it ugly? Absolutely. Have I done it? Yes. Unfortunately, it’s part of the game. And more often than not, even after weeks of panic-inducing headlines, the contract gets signed at the 11th hour.

The real problem? Patients are left confused, worried, and sometimes without access — often for no good reason.

So, if these high-stakes standoffs aren’t going away anytime soon, what can patients actually do when they’re caught in the crossfire?

How Can Patients Navigate a Potential Breakup Between Their Doctor and Insurer?

Break ups suck. Simply put, 90% of the time, they suck. And they exist everywhere, even in healthcare. Navigating a breakup between a doctor and an insurance company can be tricky for patients, but there are practical steps to make the ice cream eating stage go a bit more smoothly:

Continuity of care exception: If you're in the middle of treatment (like pregnancy, cancer, post-surgery care), you may be eligible to continue care under special provisions.

Look for other doctors: If switching is necessary, ask your current doctor for referrals to in-network providers.

5. Check Your Insurance Plan
Out-of-network costs: Review your benefits to understand how much you'll pay if you keep seeing your current doctor (make sure to keep all receipts in case the breakup isn’t official and rescinded!)

Appeal process: If your preferred doctor is no longer covered, see if you can file an appeal for continued care or reimbursement.

They’ll also work with your insurance company and provider to resolve issues without you getting stuck in the middle of both parents.

Talk to your insurer: Customer service can clarify what’s covered, offer help finding new providers, or explain any short-term options.

Sample scripts for future patient/insurer breakups

Here are two sample scripts to bookmark should a patient/insurer breakup ever be in your future — one for calling or writing to your insurance company, and one for your doctor’s office.

Dear [Insurance Company Name] Member Services,

I am writing to request assistance regarding the recent change in network status for my healthcare provider, Dr. [Doctor’s Full Name], who I understand will no longer be in-network as of [date].

I have been receiving ongoing treatment from Dr. [Name] for [brief description of condition, e.g., a chronic illness, pregnancy, post-operative care], and I would like to request a continuity of care arrangement so I can continue seeing them at in-network rates during this transition.

Please let me know what documentation you require and the next steps to initiate this request. I appreciate your help in ensuring there is no disruption in my medical care.

Sincerely,

[Your Full Name]

[Date of Birth / Member ID]

[Contact Info]

Dear Dr. [Doctor’s Last Name] and Office Staff,

I was recently informed that your practice may no longer be in-network with my insurance provider, [Insurance Company Name], as of [date]. I greatly value the care I’ve received and would like to understand my options moving forward.

Can you confirm whether negotiations are ongoing or if you anticipate rejoining the network? Additionally, are there payment options, discounts, or support for patients who wish to continue care out-of-network?

I’d also appreciate referrals to trusted in-network providers if a transition becomes necessary.

Thank you for your time and care.

Sincerely,

[Your Full Name]

[Patient ID or DOB]

[Contact Info]

The Bottom Line

Contract disputes between insurers and healthcare providers are complex, high-stakes negotiations — and unfortunately, patients often get caught in the middle. But staying informed, knowing your rights, and communicating clearly with both your provider and insurer can help you navigate the chaos.

These fights may be out of your control, but how you respond doesn’t have to be. Advocate for yourself. Ask questions. Use the tools available to protect your continuity of care.

Further Reading:

• Texas Department of Insurance Consumer Help – For understanding rights and filing complaints.
• No Surprises Act Information – Guidance for patients about out-of-network billing protections.