Your insurance plan may restrict your choices to a group of plan-approved physicians or offer financial incentives to use plan-affiliated doctors. Always check the terms of your insurance coverage to find out whether the plan will cover visits to the physician you are considering. If he or she does not participate in your health plan, how much will you pay out-of-pocket for visits to this provider? Does the health plan require a referral from a primary care physician before you can see a specialist? If you have changed jobs and must decide among different health plans offered by your employer, you may want to make your choice of doctor first and then choose the health plan that covers visits to this physician.
You will also need to decide what type of physician you are looking for. Most plans require you to choose a primary health care provider (a doctor who will manage your overall care and refer you to specialists when needed). In addition, if you have a chronic or disabling condition you will likely need a specialist who understands your particular health needs.
Most practicing physicians in the U.S. are board certified. Primary care physicians -- doctors you would see for routine ailments such as a cold, the flu, and regular checkups -- may be board certified in family medicine or internal medicine; specialists -- doctors you would see for special procedures such as a colonoscopy or for a chronic disease -- have completed residency training in a specific field following graduation from medical school and have passed a competency exam in that field.
It is also possible to find out whether a doctor is in good standing with state licensing agencies through a Web site run by administrators of several state medical licensure boards. The site Administrators In Medicine can provide information about disciplinary actions taken or criminal charges filed against physicians in many states.
- Where is the practice located? Will it be easy for you to get there? Is it accessible by public transportation? Is there ample parking?
- Which hospital(s) does the doctor use? Are you comfortable with the possibility of being treated at one of these institutions should the need arise?
- Where are routine X-rays and lab studies performed? Can these be done in-office, or will you have to go to an outside lab?
- How long must you wait for an appointment after you call? Can you be seen on the same day if you have an urgent need?
- Is the office staff friendly and courteous?
- If you call with a question about your care, does a doctor or nurse return the call promptly?
- Who covers for the physician when she is away? Whom should you call if you have a problem after-hours? If the doctor works in a group, are you comfortable with being seen by one of the practice partners?
- Does the physician frequently refer patients to specialists
or does he/she prefer to manage the majority of your care themselves?
- Does the office process insurance claims, or must you pay up-front for services and file the claims yourself?
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