Health Insurance Doctors
[In managed care plans, health insurance doctors may be in different employment categories. In a pre-paid HMO/clinic plan, the doctor is an employee or member of the clinic, resulting in a small number of health insurance doctors being available. In PPO and HMO networks, the doctor is in private practice, so there are many more health insurance doctors available in-network, more in a typical PPO network than in an HMO network. - ed.]
Tips on Choosing a Doctor
Your doctor will be your partner in care, so it is important to choose carefully from the doctors available to you. In some managed care plans, you will generally be limited to choosing from only certain doctors; in other plans, some doctors may be "preferred," which means they are part of a network and you will pay less if you use them. Ask your plan for a list or directory of providers. The plan may also offer other help in choosing.
[Referring to health insurance doctors as "preferred" by virtue of being in a PPO, i.e., Preferred Provider Organization, may not not mean much more than the doctor agreeing to a schedule of fees and a protocol for filing claims, and paying a small charge to join the network. The health insurance doctors in the network may have to be "credentialled", but all doctors have to have some medical credentials or they could not be in practice. - ed.]
You can ask doctors you know, medical societies, friends, family, and coworkers to recommend doctors. You may also contact hospitals and referral services about doctors in your area.
Once you have the names of doctors who interest you, make sure they are accepting new patients. Here's how to check doctors out:
- Ask plans and medical offices for information on their doctors' training and experience.
- Look up basic information about doctors in the Directory of Medical Specialists, available at your local library. This reference has up-to-date professional and biographic information on about 400,000 practicing physicians.
- Use "AMA Physician Select," which is the American Medical Association's free service on the Internet for information about physicians (http://www.ama-assn.org/aps/amahg.htm).
You may also want to find out:
- Is the doctor board certified? Although all doctors must be licensed to practice medicine, some also are board certified. This means the doctor has completed several years of training in a specialty and passed an exam. Call the American Board of Medical Specialties at 800-776-2378 for more information.
- Have complaints been registered or disciplinary actions taken against the doctor? To find out, call your State Medical Licensing Board. Ask Directory Assistance for the phone number.
- Have complaints been registered with your State department of insurance? (Not all departments of insurance accept complaints.) Ask Directory Assistance for the phone number.
Once you have narrowed your search to a few doctors, you may want to set up "get acquainted" appointments with them. Ask what charge there might be for these visits, if any. Such appointments give you a chance to interview the doctors—for example, to find out if they have much experience with any health conditions you may have.
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[Health insurance doctors who are in private practice and are members of an HMO may have to be "credentialled" before becoming members, but that is not a substitute for checking out a doctor yourself if that is important to you. Is there any reason to conclude that health insurance doctors who are "credentialled" members of an HMO are more qualified physicians on the average than non-HMO member doctors? - ed.]