Glossary

Network of Doctors

When you're choosing a health plan, one of the main things to consider is the plan's network of doctors. 

Each health plan has a group of doctors who have an agreement with the health plan to charge a set lower amount for services. It's best to see one of these participating providers to get the best value.   

If you already have a primary care provider (PCP) and want to continue seeing them, check with the health plan you're considering to make sure your doctor participates with that plan. The same goes for specialists, dentists, labs, and so on. You can usually find this information on the plan's website or in their provider directory. 

If you don't have a PCP, you might want to check the plan's network of doctors to see if any meet your criteria, such as their location and specialty. You'll find more information about choosing a doctor below. 

Choosing a Doctor

Remember that great restaurant your friend told you about? You were a little skeptical, but after reading the reviews, checking out their menu online, and doing a quick drive-by, you went and had an amazing meal.

Now, remember that doctor you saw – the one you chose after reading about their credentials, asking for recommendations, and looking into their specialties? … Yeah, didn't think so.

You have strict standards when pleasing your taste buds; you should give your mind and body the same respect. Whether you're choosing a PCP, specialist, or a pediatrician for the kids, it's important to do your homework to get the best care. 

Your health insurer probably has a directory of doctors you can browse by health plan, specialty, location, and other criteria. This is a good place to start. You can also ask friends, family, or other doctors for recommendations.

 

Think about what's important to you, then call that doctor's office to get answers from the staff. No shame! Communication is the key to a good patient/doctor relationship. Here are some questions to consider:

Insurance

  • Does the doctor accept your health insurance?
  • What are the fees for services?
  • Does the office file claims or do you have to pay up front and file claims yourself? 

Convenience

  • Where is the office located? Is it easy to get there?
  • How long do you have to wait for an appointment? What if it's urgent?
  • Where should you call if you have a problem after-hours?
  • Can you email them with questions? 

Credibility

  • Is the doctor certified by a specialty board?
  • Which hospital(s) does the doctor use?
  • How long has the doctor practiced?  

Comfort

  • Who will provide care when the doctor is away?
  • If you're picking a doctor for a specific condition, how often do they treat cases like yours?
  • Do you prefer a male or female? Does age matter? What about ethnicity or languages spoken?
  • Is the office staff helpful and friendly? 

Preference

  • Does the doctor frequently refer patients to specialists or do they manage most care themselves?
  • Will the doctor treat your entire family?
  • Where are X-rays and lab tests performed – in-office or at an outside lab?
  • Does the doctor perform surgery?
  • Does the doctor provide prenatal care and deliver babies? 

If you have an HMO plan, stay within your health center. 

If you're in an HMO plan, you should see doctors within your health center to save money. (Not sure what an HMO is? We explained it here.) Your health center has a contract with your health insurer to charge a certain amount. Doctors outside your health center can charge you more. That could really hurt. 

You may or may not need a referral from your PCP to see another doctor or specialist. If your PCP refers you to another doctor, make sure that doctor is within your health center.

Of course, you can visit any doctors you choose, but if they're not in your health center, you'll probably pay a lot more.

People with a PPO plan don't need to choose a PCP, but they should! Learn why a PCP is important.

Those with an HMO plan are required to choose a PCP and health center. Don't skip this step or your insurer could assign one to you. 

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