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My doctor is leaving my plan's network in the middle of my treatment. Can I keep the in-network rate?

Health insuranceWho paysTexasChecked Nov 6, 2026

From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: Texas Insurance Code · Chapter 1301 · § 1301.153(a)(2) (Continuity of Care) View original ↗

In short

  1. Texas can keep you at the in-network rate when your doctor leaves [2].
  2. It applies when stopping that care could harm you [1].
  3. It does not apply if the doctor left over competence or conduct [2].

What this means

Texas has a rule for this, and it turns on two words: special circumstances. That means a condition where your treating doctor reasonably believes that stopping that care could cause harm to you [1]. The law gives examples. A disability. An acute condition. A life-threatening illness. Being past the 24th week of pregnancy [1].

Read the condition that comes with the rule. Each contract between an insurer and a doctor must cover what happens when the doctor leaves the plan [2]. The leaving does not release the insurer from paying at the same preferred provider rate [2]. But there is a carve-out. That does not hold if the doctor left for reason of medical competence or professional behavior [2]. And it holds only if you were in treatment with special circumstances at that time [2].

The doctor has to start it, not you. The treating doctor identifies the special circumstance [3]. The doctor then asks that you be allowed to keep treatment under their care [3]. And the doctor agrees not to seek payment from you of any amount you would not owe if the doctor were still a preferred provider [3].

The window ends. These sections do not extend the duty to pay at the preferred level past the 90th day after the end date [4]. Were you diagnosed with a terminal illness at that time? Then the limit is nine months [4]. One case runs longer. Past the 24th week of pregnancy, the duty runs through delivery [4]. It covers the care right after birth [4]. And it covers the checkup within six weeks [4]. Your plan owes you warning too, with a condition. The insurer must give reasonable advance notice, subject to Section 1301.160, that a doctor who treats you is leaving [5]. These sources do not quote Section 1301.160, so they do not say when it changes that duty. If a preferred provider leaves, the insurer must also make a current list of preferred providers available to you [5]. These rules sit in the chapter on preferred provider plans. These sources do not say which rule covers an HMO, or a plan that pays its own claims at work.

Your next step

Ask your doctor to put your special circumstance in writing [3]. Ask for the request to keep treatment in the same letter [3]. Ask for the promise not to bill you above your in-network share [3]. Send a copy to the plan, and ask it to confirm the rate and the end date it will use [2] [4]. The clock these sources give is 90 days: the duty to keep paying at the preferred level does not run past the 90th day after the end date [4].

Check it yourself

Find the termination date in the notice your plan sent, then count 90 days from it [4]. Read your plan booklet section on continuity of care or transition of care next to that date. Whether your own condition counts as a special circumstance: "Don't know yet" here, because the treating doctor decides that first [1][3].

Where this comes from (5)

  1. [1] Texas Insurance Code · Chapter 1301 · § 1301.153(a)(2) (Continuity of Care) · checked 2026-11-06

    “Special circumstances” means a condition regarding which the treating physician or health care provider reasonably believes that discontinuing care by the treating physician or provider could cause harm to the insured. Examples of an insured who has a special circumstance include an insured with a disability, acute condition, or life-threatening illness or an insured who is past the 24th week of pregnancy.

  2. [2] Texas Insurance Code · Chapter 1301 · § 1301.153(b), (b)(2) (Continuity of Care) · checked 2026-11-06

    Each contract between an insurer and a physician or health care provider must provide that the termination of the physician's or provider's participation in a preferred provider benefit plan, except for reason of medical competence or professional behavior, does not … release the insurer from the obligation to reimburse the physician or health care provider or, if applicable, the insured, at the same preferred provid…

  3. [3] Texas Insurance Code · Chapter 1301 · § 1301.153(c) (Continuity of Care) · checked 2026-11-06

    The treating physician or health care provider shall identify a special circumstance. The treating physician or health care provider shall: (1) request that the insured be permitted to continue treatment under the physician's or provider's care; and (2) agree not to seek payment from the insured of any amount for which the insured would not be responsible if the physician or provider were still a preferred provider.

  4. [4] Texas Insurance Code · Chapter 1301 · § 1301.154(a)-(b) (Obligation for Continuity of Care of Insurer) · checked 2026-11-06

    Sections 1301.152 and 1301.153 do not extend an insurer's obligation to reimburse the terminated physician or provider or, if applicable, the insured at the preferred provider level of coverage for ongoing treatment of an insured after: (1) the 90th day after the effective date of the termination; or (2) if the insured has been diagnosed as having a terminal illness at the time of the termination, the expiration of t…

  5. [5] Texas Insurance Code · Chapter 1301 · § 1301.152(b) (Continuing Care in General) · checked 2026-11-06

    An insurer shall: (1) provide, subject to Section 1301.160 , reasonable advance notice to an insured of the impending termination of the participation in the plan of a physician or health care provider who is currently treating the insured; and (2) in the event of termination of a preferred provider's participation in the plan, make available to the insured a current listing of preferred providers.

How we found this

We matched your question to 5 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-06.

What we don’t know yet

Your own plan or notice may say something different. If your letter cites another rule, send it and we will look again.

Every answer is checked against the official rule it quotes.

Information only — not legal advice. Your plan, insurer or agency decides.

This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.

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