Now that you’re an adult (or maybe a very responsible teenager), it’s time you learn how to find the right healthcare provider! “Healthcare provider” is a term that includes a wide range of medical professionals, including primary care physicians, specialists, physician’s assistants, nurses, physical therapists, chiropractors, acupuncturists – the list goes on and on.
Regardless of what type of provider you’re looking for, this article will help guide you so the process is as straightforward as possible. I know when I first started, I didn’t know the first thing about setting up appointments, let alone finding a doctor that was covered under my insurance plan. It was a whole ordeal that definitely caused a lot of anxiety. Luckily, you won’t be in that situation! Let’s jump into it. 🙂
Table of Contents
What Is an In-Network Provider?
The first thing you’ll need to do is find a provider that is in-network. In-network providers are licensed medical professionals or healthcare systems that have a contract with your insurance company to provide care at a discounted rate. When you see an in-network provider, one of the following will happen, depending on whether your plan has copays, a deductible, or both:
- If you have copays: Insurance will cover the cost of the visit, and you’ll just need to pay the copay amount. Copays typically range from $15 for primary care visits to $300 for emergency room visits. If you’re looking for a primary care provider or specialist, you’ll most likely be looking at the $15 to $25 range.
- If you have a deductible: You’ll cover all medical expenses out-of-pocket, until you hit your deductible amount. Keep in mind that only in-network providers and services that follow your specific plan’s guidelines will count towards your deductible. Afterwards, your insurance will start contributing.
Why Do I Need to Find an In-Network Provider?
Going to see an in-network provider means that your insurance has some level of financial responsibility in your medical expenses. The other option is to see a provider who is out-of-network. Visits with out-of-network providers will not be covered by your insurance, and you’ll have to pay for all costs out-of-pocket.
Step 1: Find an In-Network Healthcare Provider
Option #1: Insurance Member Account
There are two ways to find an in-network provider. The first is through your member account on your insurance’s website.
Here’s a step-by-step on how to access your member account and find an in-network provider:
- Go to your insurance company’s website.
- If you haven’t already, create an account. You’ll need to provide some personal information, along with information found on your insurance card.
- After you’ve created your account, log in with your username and password.
- Click on “Find a Provider.” This option may be worded slightly differently (e.g. find a doctor, provider search, etc.), depending on your insurance site.
- Select the type of plan you have. You should be able to find this information on your insurance card.
- Search for the type of healthcare provider you’re looking for (e.g. family doctor, cardiologist, physical therapist).
- Enter your location. Oftentimes, you’ll also be able to input how far you’re willing to travel, and the site will narrow down its search to offices that are within a certain mile radius from your location.
- Click “Search” and you should get a list of provider matches!
Option #2: Call Your Insurance
Let’s say for whatever reason you don’t have your insurance login information. Maybe you’re on a parent’s insurance plan, or maybe you forgot your login info and don’t have time to get it sorted out right now. In any case, another way that you can find an in-network provider is to call your insurance.
Here are the steps for calling your insurance to obtain a list of in-network providers:
- Call the number on the back of your insurance card that’s specifically for patients. If you can’t find it on your card, then you can also find it online.
- You’ll be greeted by a voice automated system that will direct you to the correct department. You’ll need to provide your member ID number (on your insurance card), date of birth, zip code, and what you’re calling about.
- The automated system will connect you with a representative. Give a quick greeting and let the representative know that you’re looking for a specific type of provider that is in-network.
- The representative will first ask you to reconfirm your information (name and date of birth), as well as ask for a good callback number in case your call gets disconnected. Then, they will compile a list of in-network providers that fit your description and email that list to you.
- This is the time to ask any questions you may have. Some of the questions that I often ask are: “Is this covered under my insurance plan?” and “How much will I need to pay out-of-pocket?”
- You should receive the list of providers in your email within 5 minutes or so. If all of your questions have been answered, thank the representative for their help and hang up.
Pro tip: Voice automated systems can be extremely annoying. If you find yourself not getting redirected to where you need, you can say “Speak to a representative,” and most automated systems will connect you to a real person. Another option would be to connect to the wrong department and have the representative that takes the call personally redirect you from there.
Some types of care, particularly physical therapy, chiropractic care, acupuncture, and massage therapy may be covered but only under certain circumstances. If you’re looking for any of these services, be sure to ask how much your plan would cover and under what conditions. Recently, I was looking for a chiropractor, and my particular plan required that I needed to be seen for pain specifically, in order for in-network chiropractic visits to be covered. Make sure that you’re aware of any similar conditions in your plan. It’s important to ask before your visit so you’re not unexpectedly hit with a large bill. (If you are in this situation though, be sure to check out my article on what to do if you have a medical bill that you can’t pay.)
As you can see, there are plenty of benefits to actually calling your insurance when trying to find a provider versus using the “Find a Provider” option on their website. Not only can a representative answer any questions you may have, but they will also email you a personalized list that you can refer back to at a later time. Ultimately, it’s up to you which method you choose.
Step 2: Pick a Provider from Your Insurance List
This is where you’ll have to use your own judgment. When it comes to choosing a provider, it really comes down to their expertise and your own preferences. As a rule of thumb, I like to research at least five different providers options.
When it comes to the provider, one thing you can do is search up ratings and reviews to see if other patients recommend them. Here are some specifics you’ll want to look at:
- Double check that the provider offers the services you’re looking for. This is especially the case with specialists. For example, let’s say you have diabetes and are looking for an endocrinologist. You’ll want to make sure that the endocrinologist that you choose actually takes diabetic patients. This might sound strange, but many endocrinologists actually focus on specific areas within the field (e.g. bone health, reproductive health, thyroid disorders) and may not actually see patients for just any type of endocrine disorder. Many providers will have a profile that lists the types of conditions they treat. If you’re unable to find this information online, you can always check with the office when you’re scheduling your appointment.
- Be sure to look at several different websites. There are plenty of sites that have ratings and reviews on providers so check out a few to get a better picture.
- Remember to take ratings and reviews with a grain of salt. It’s usually the few people who have the strongest opinions that end up leaving ratings and reviews, which often leads to artificially negative reviews. It might be the case that the majority of a provider’s patients are very pleased with the care that they received but didn’t leave a rating nor review so you may not see all of those positive opinions factored in.
- Make sure to read actual reviews, not just ratings out of five stars. Reviews will explain why someone was or wasn’t happy with the care. More importantly, see if there are multiple reviews that say the same thing. If so, you’ll probably want to take what’s being praised or criticized into consideration. If not, recognize that it might’ve been a one-off thing, or that the patient was difficult.
Now that we’ve covered what to look for on the provider’s end, it’s time to factor in your personal preferences. This includes any specific accommodations, such as language and wheelchair accessibility. Additionally, if you have a busy schedule and limited availability, you might want to look at when different providers’ offices are open. For instance, some places may be open from 8 AM to 5 PM Mondays through Saturdays, while others may only be open from 9 AM to 4:30 PM Mondays through Thursdays. With all of this in mind, you can pick the provider that you think would be the best fit for you.
Step 3: Schedule a Doctor’s Appointment
The next step is to schedule your appointment. You can find the phone number to call under your provider’s name in your search or on the list that was emailed to you. When you call, make sure you have the following information on hand:
- Personal info (full name, address, phone number, email address)
- Insurance card
- Reason for visit
- Dates and times that you’re available
Don’t delay scheduling your appointment. Depending on how busy a provider’s office is, you may not be able to get an appointment for several weeks. If you need to be seen more urgently, you can either opt for a different provider or take a look at my article on primary care, urgent care, and emergency care for other options in the event that you’re dealing with a more time-sensitive issue and can’t wait that long for an appointment.
After you’ve scheduled your appointment, mark it in your calendar so you don’t forget. Congrats! Now all you have to do is show up. 😀
Pro tip: If something comes up and you need to reschedule or cancel your appointment, make sure to call well in advance. Many offices charge a late cancellation fee, and some may refuse to see you if you cancel or no-show too many times. It differs from office to office, but it’s usually required that you call at least 72 hours in advance for rescheduling and cancellations.
Step 4: Bring The Essentials To Your Appointment
You’ve got all the hard stuff out of the way, and all that’s left to do is to show up to your appointment. Make sure to arrive 15 minutes early; most places will ask you to do this – especially if you’re a new patient – because you’ll need to take some time to fill out paperwork. From personal experience, I would recommend giving yourself plenty of time in addition to the 15 minutes, in the event that you have trouble finding parking or locating the office. If you arrive too late, the office may not see you.
Lastly, make sure you have all of the things you need with you. I’ve made a list below of things to bring to a doctor’s visit so you don’t have to worry about forgetting anything:
- ID
- Insurance card (Even if you already gave the office your insurance information when you scheduled the appointment, they’ll likely scan your card so they have a copy.)
- Payment method
- List of current medications
- Medical history
- Any questions you may want to ask your doctor
Conclusion
Good work on making it to the end of this article! Now, finding a provider won’t be such a daunting task. If you found this article helpful, be sure to check out my other ones on how to navigate the healthcare landscape. Until next time! 🙂