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How To Choose A Primary Care Doctor

Step 3. Locate A Doctor Who Fits Your Insurance Or Financial Situation

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For many people, the choice of doctor is limited because of the dictates of their insurance plan.  If there is no limitation, there are sources that are helpful for locating a doctor who fits your criteria. The following information helps you locate a doctor depending on the type of health insurance you have, or if you don't have health insurance.

Managed Care Health Insurance Such As An HMO, PPO or POS (where choice of a doctor is limited by your plan)

If you have a managed care health insurance plan, such as an HMO, PPO or POS: the health plan will provide a list of doctors from which to choose.

Save time by only reviewing the most up-to-date list. Generally this list is found on line.

If a doctor you'd like to consider isn't on the list, ask the doctor's office if she or he would be willing to contract with your insurance carrier. If not, it could be helpful to you to learn why not. It may provide information to watch for with respect to the doctors who are on the plan.

If the doctor is willing to be on the list, speak with the insurance company and ask if the doctor could be put on their list. If the company says no, it may also be helpful to know why not.

A Private Fee-For Service Insurance Policy (also known as an Indemnity Policy) and Original Medicare -- where you have the choice of any doctor

Under a Private Fee-For-Service (Indemnity) Insurance Policy you have an unlimited choice of specialists.  See the section below about how to choose a doctor when insurance is not a primary factor in choosing a primary care doctor.

Medicare Advantage or Medicare Plus

If you have a Medicare managed care health insurance plan, such as an HMO, PPO or POS, the health plan will provide you a list of doctors from which to choose.

If a doctor you know you'd like to consider isn't on the list, ask the doctor's office if she or he would be willing to join your insurance carrier. If not, it could be helpful to you to learn why not. It may provide you information to watch for with respect to the doctors who are on the plan.

If the doctor is willing to be on the list, speak with the insurance company and ask if the doctor could be put on their list. If the company says no, it may also be helpful to know why not.

For a list of doctors who accept Medicare, see www.medicare.gov offsite link  (click on "Search Tools" than "Find a Doctor").      

If a doctor you'd like to consider isn't on the list, ask the doctor's office if she or he would be willing to accept Medicare. The odds are the doctor has considered it, and rejected the idea - but it's worth a phone call. If the doctor is willing to be on the list, call Medicare at 800.MEDICARE.

Medicaid

If Medicaid pays for a private managed health care plan: If you have a managed care health insurance plan, such as an HMO, PPO or POS, the health plan will provide you a list of doctors from which to choose.

You may be limited to a choice of designated participating physicians or medical groups. Check your plan to obtain your choice of doctors. If there are no doctors who can provide you with the quality of care that you require, you will likely have to advocate for yourself to see a doctor outside of the network plan.

If a doctor you'd like to consider isn't on the list, ask the doctor's office if she or he would be willing to join your insurance carrier. If not, it could be helpful to you to learn why not. It may provide you information to watch for with respect to the doctors who are on the plan. If the doctor is willing to be on the list, speak with the insurance company and ask if the doctor could be put on their list. If the company says no, it may also be helpful to know why not.

If you do not have a managed health care plan through Medicaid: To locate doctors who accept Medicaid, contact your local Medicaid Office.

If the offices does not have a list, locate doctors who accept Medicaid through:

  • Hospitals: Contact your local hospital, particularly community hospitals. The better the hospital, the better their doctors are likely to be. Ask to speak with one of their social workers.
  • Local disease specific non-profit organizations may know the names of doctors who accept Medicaid.
  • Support Groups: If you are a member of a support group, other members may have suggestions about doctors who accept Medicaid.
  • Clergy: Your local religious organization will likely know the name of doctors who accept Medicaid.
  • Friends and Family: People in a situation similar to yours may have doctors to recommend.

If Health Insurance Is Not A Primary Factor in Choosing A Doctor

The following suggestions should help you locate a doctor who fits your needs in your area, and help you to narrow your choices.

  • Professional Groups If you are looking for a particular type of primary doctor, professional groups provide a helpful place to start:
    • Internists: To locate internists who are board certified, call the American Board of Internal Medicine, tel.: 215-446-3500 1-800-441-2246, www.abim.org offsite link
    • Geriatric doctors: American Geriatrics Society www.americangeriatrics.org offsite link AGS Referral Phone Line:  800.247.4779
    • Family Physicians: American Academy of Family Physicians www.aafp.org offsite link 800.274.2237
  • Healthcare Professionals
    • Ask doctors, nurses or other healthcare professionals for the names of doctors who fit your criteria. Healthcare professionals can often provide valuable "inside" information about the doctors as well. They may also be able to tell you which doctors to avoid.
  • Local Prestigious Hospitals or Large Teaching Hospitals in your Area:
    • If such a hospital is nearby:  Stop by and ask a nurse in the Emergency Room or in the Intensive Care Unit (ICU) or a hospitalist (a doctor who only works in a hospital) who s/he would use, and why. Think about saying something like: "I'm new to town. I have to choose a new doctor who has privileges at this hospital, most ideally one who is particularly good at treating patients with (mention your diagnosis.)  I know all the doctors here are great, but I'd appreciate your telling me which specific doctors you would consider if you were me."
    • If a hospital is not nearby: Call their doctor referral service. You will only receive a list of doctors who are affiliated with their hospital, but these types of facilities tend to attract the "cream of the crop."  
  • Local Medical School
    • Contact the medical school located closest to you.  Explain the type of doctor that you are looking for and ask for recommendations.  Some instructors actually maintain their own medical practices and tend to be informed on the latest recommendations, procedures and treatments.
  • Family and Friends
    • Consider asking family and friends whose opinions you trust for the names of doctors with whom they have had a successful relationship.  
    • Ask members of your support group or self help group.
    • Don't rely solely on their opinion. What works for one person does not necessarily work for another person. We are all individuals.  Further, one person's experience with a particular doctor may be an exception. Do your own research about the doctor.
  • The Internet 
    • There are many easily accessible sites about doctors on the internet.  Unfortunately, there is no one-stop shopping. You can use the sites below to create a list of potential doctors.  These sites can also help you compare the qualifications of doctors whose names you have, or they can help you locate doctors who meet your criteria.
    • For a list of suggested sites, see Leading Sites For Locating a Doctor. All services are free of charge except where noted.

 

 

 

 


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