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When Specialty Care Goes Out of Network: How to Support Patients' Access to Care

August 10, 2026

Key Takeaways for Busy Providers

This year, over 22,000 patients with Medicare Advantage plans still receive care at Moffitt by using their out-of-network benefits.
Moffitt's insurance team can pursue out-of-network authorizations, network exceptions and Transition of Care or Continuity of Care coverage on behalf of patients. They can be reached at 855-856-4560 for any questions.
Patients with Original Medicare can receive care at Moffitt, and most Medicare Supplement (Medigap) plans are also accepted.
Moffitt accepts Original Medicare and select Medicare Advantage plans.
Moffitt's Medicare Advantage Navigators help patients understand their available coverage. Call 855-856-4560 or email FCUinsuranceNavigator@moffitt.org.

Understanding the Medicare Advantage Landscape

Many specialty care providers, including cancer centers, are facing network contractions with Medicare Advantage plans. These changes are affecting access to complex, specialized care across multiple disciplines, and your patients may be looking to you for guidance.

Moffitt Cancer Center has experienced this challenge firsthand. Like many specialty providers, we've seen payers make business decisions to narrow their networks; these decisions have been unrelated to quality of care or clinical outcomes. We understand the frustration this creates for referring physicians who want to ensure their patients have access to the best possible cancer care.

What Your Patients Need to Know

When patients learn specialty providers are out of network, many assume they've lost access entirely. As their trusted physician, you're in a unique position to help them understand their options:

Medicare Advantage Plan Changes

During open enrollment (usually mid-October through the beginning of December), patients can switch to a different Medicare Advantage plan that includes access to their preferred specialty providers through out-of-network benefits (PPO plans), or switch back to Original Medicare if eligible. These plan changes will take effect in January of the following year.

Out-of-Network Benefits

Many patients don't realize that PPO plans typically include out-of-network benefits with a maximum annual out-of-pocket benefit. While costs may be higher, access to specialized care remains available. HMO plans generally don't include out-of-network benefits, but exceptions can sometimes be made.

Advanced Cancer Care

Many payers have created in-network contracts for highly specialized treatments such as bone marrow transplants, CAR-T therapy, or tumor-infiltrating lymphocyte (TIL) therapy. In addition, federally sponsored clinical trials are always available to Medicare Advantage patients.

To help patients navigate their choices, Moffitt's insurance team is available at no cost by calling 855-856-4560 or emailing FCUInsuranceNavigator@Moffitt.org.

Having the Conversation With Your Patients

Acknowledge Their Concern

Patients may be frustrated or worried about network changes affecting their specialty providers. Offer to look at their options together.

Review Their Current Plan

Help patients understand whether they have a PPO, which typically allows out-of-network access, or an HMO, which generally requires in-network care unless an exception is granted.

Discuss Open Enrollment

If the conversation happens during enrollment season, remind patients they can change plans. Certain life events may also trigger special enrollment periods outside this window.

Explain Exception Processes

For patients requiring highly specialized treatments, let them know their specialty provider can request network exceptions, particularly when they're the only facility capable of providing specific advanced therapies.

Emphasize Advocacy

Reassure patients that specialty providers will work to obtain necessary authorizations, though final decisions rest with the insurance company.

How Moffitt Supports Continuity of Care

When you refer patients to Moffitt, we're committed to helping them navigate insurance challenges:

Our Financial Clearance Unit reviews Medicare Advantage options that include Moffitt in-network
We pursue out-of-network authorizations on patients' behalf when appropriate
For specialized treatments requiring unique capabilities, we advocate for network exceptions
We accept Original Medicare and participate in select Medicare Advantage networks

As we navigate the changing Medicare landscape together, maintaining open communication between referring physicians and specialty centers ensures patients receive the comprehensive, advanced care they deserve.

Moffitt remains committed to accepting Original Medicare and participates in select Medicare Advantage networks. For questions about specific patient referrals or insurance coverage, contact our Financial Clearance Unit at 855-856-4560. To refer a patient you can fill out our online form or contact a physician liaison at Physician.Relations@Moffitt.org for assistance.

Connect Your Patients with an Insurance Navigator for Personalized Guidance

To help patients understand all their options, Moffitt offers Medicare Insurance Navigators who can help explain what each option means. Healthcare providers or patients can reach them at 855-856-4560 or FCUInsuranceNavigator@Moffitt.org.

You can also share this Patient Resource: Moffitt.org/MedicareAdvantage - Moffitt's Medicare Advantage Guidebook for Patients.