Simplify the Search for a New Doctor With These Helpful Tips and Suggestions
When it comes to finding a good in-network health provider, it can seem overwhelming. Whether your insurance has changed or your existing doctor is leaving the network, searching for a new one doesn’t have to be stressful. Start with contacting the provider’s website or their office directly to see if they accept the correct health plan. You should also check through the insurance company too. Here are some good starting points moving forward.
Each medical care provider has a preset list of insurance companies they work directly with. Doctors and their care team associates typically only accept patients with certain types of insurance. They may also work with individuals with limited insurance or those on a payment plan. Some of the different insurance types include:
- HMO or Health Maintenance Organization — Coverage is limited to doctors who contract with the HMO exclusively.
- EPO or Exclusive Provider Organization — Patients must use hospitals or doctors within the managed care plan in that particular network.
- POS or Point of Service — Significant cost savings are instituted by using their specific set of providers. Must have a referral to see a specialist.
- PPO or Preferred Provider Organization — Must use doctors and providers within a specific network for full coverage. Patients may use outside providers but it will cost more.
Knowing what type of insurance you have and what network you are in is important information to have before searching for a new provider. Also, be sure to have your ID card handy as you search as providers may want to verify your coverage before setting an appointment. The insurance company should send out a list of providers to choose from during their enrollment period or provide online access to one.
Start With the Insurance Company Website
Patients can locate a new provider that takes their insurance by visiting the insurance website directly. Make sure to have the insurance ID card handy. Setting up a user account is required for HIPAA and privacy concerns so take care of that as soon as you get your new coverage notification.
From there, a list of providers should be available. It should also list the doctor’s specialty, if they are accepting new patients and any other requirements such as co-pays and local hospitals they are affiliated with. Searching by geographical area within a certain number of miles of your home can be helpful as well.
Provider Office and Website
Finding an in-network provider can be done by contacting the doctor or clinic the patient wishes to see. If they have a website, insurance information is usually listed there. Be sure to look for the exact name of your plan as listed on your ID card. Several insurance companies offer a variety of options with slightly different names and varying coverage levels. Not all providers will necessarily accept all the plans that a company offers. Follow up directly with the office, because insurance plans they carry change frequently.
Why Is an In-Network Provider Important?
Maybe a patient has been seeing the same doctor for years but their employer has just switched insurance companies. If the doctor doesn’t participate in that network, a new one needs to be found to take advantage of the new coverage plan.
This task can be complicated by the fact that not all doctors accept new patients. That’s why, even if a provider is on the insurance company’s list it’s important to call the doctor’s office directly and ask if they take a specific insurance type. Remember to check on prescription coverages also and see what’s covered and if out-of-pocket drug costs need to be considered.
When it comes to accessing health care, finding a new provider can be a challenge. The best advice is to look for a new doctor or clinic location before you need one. This will ensure you have someplace to go if you have an urgent need.
~Here’s to Your Financial Health!