Find a Doc

By Elie Harriett

When you are sick, the key to getting better is having a great doctor.  A great physician is a very personal choice and one of those decisions you can make that have a huge impact on your lifestyle.  Some people stay with their primary care doctors for over 30 years, while others change every few.  It is a personal choice, and finding the right primary care doctor is essential to your long term well-being.

That is why health insurance companies try very hard to be as inclusive as they can.  No insurance can cover 100% of all doctors throughout the United States.  Even Medicare, arguably our nation’s largest network, has a few doctors and hospitals who do not take it.  But companies do try to have the largest array of doctors and hospitals they can offer.  The more providers an insurance company has participating in their networks, the more people they will get to sign up for coverage.  That’s why many insurance companies have tools available to help you find the physician you are looking for.

If you are computer savvy, your insurance company generally has a provider locator tab on their website.  From there, you can search your insurance company to see if a specific doctor or hospital is part of your insurance network. 

Another way to get these answers is to call the insurance company directly.  This is one of those few instances where we tell clients who call us to go directly to the insurance company.  Networks change on a daily basis and the most accurate way to tell if your doctor is taken by your plan is to ask the company yourselves.  Remember some plans, such as traditional Medicare Supplements, do not have networks, so if you have one of those plans, you simply need to ask your doctor if they take Medicare.  If the answer is yes, the insurance will work.

One thing to NOT do, however, is to ask the doctor’s office without showing your card.  An insurance company could have 6-20 different networks and a doctor’s office may only take 3-4 of them.  If you must ask the doctor’s office (in general, we recommend asking your insurance company), we recommend giving them your insurance card so they can match the network you are in to their acceptance of the coverage.

But what if you are trying to find a new doctor, have Medicare and a supplement, and don’t know where to start?  Good news!  As of this year, CMS (the government agency in charge of Medicare) has brought us a new service called Physician Compare.  With this new service, you can find a doctor based on your location and the type of doctor you are looking for.  It gives you information on each provider in their database, which special programs they participate in with Medicare, where they went to school and when they graduated, their group and hospital affiliations, and any board certifications.  The list isn’t all inclusive, but it is a great starting point for people looking to find a new provider to help manage their quality of care.

For more information about this or any aspect of your health insurance, contact us today.