Insurance panel removal

Insurance panel removal means an insurer formally removes a healthcare provider from its approved network, ending that provider’s ability to bill the plan for covered services. Insurers such as Aetna and UnitedHealthcare remove providers due to credentialing issues, policy violations, or low patient satisfaction scores, as recorded by Your Insurance Info.

Providers lose access to insured patients when removed from panels like Blue Cross Blue Shield or Cigna. Removal typically follows written notice per state laws; for example, California requires 60 days’ advance notification under Health & Safety Code §1374.30.

Insurance companies cite reasons including fraud investigations, repeated billing errors, or failure to meet quality benchmarks tracked by CMS metrics. Patients must switch doctors if their provider is dropped from networks like Humana Medicare Advantage or Anthem PPOs.

Reinstatement after removal often requires reapplication and corrective action plans documented in compliance reports. Appeals processes exist but succeed only about 20% of the time according to AMA data (2022).

Panel removals affect reimbursement rates since out-of-network claims pay less–often just 50-70% of in-network rates per FAIR Health data (2023).