Choose a primary care provider who takes your insurance.
Your primary care provider or PCP is the person you will go to for check-ups and if you are sick.
Your primary care provider can be a doctor, a nurse practitioner or physician assistant. To keep things simple, we will usually just say doctor.
Make sure your primary care provider is “in your plan” or “in network.” This means he or she takes your insurance.
If you go to a doctor “out of your plan” or “out of network,” you may have to pay a larger portion — or all — of the doctor’s bill yourself.
Using an “in network” provider helps you save money.
If you don’t use a primary care provider who is “in network,” it will cost you more.
How to choose a primary care provider
When you are choosing your primary care provider, there are a lot of options to consider.
You MUST find out:
- If the doctor is in your plan AND
- If he or she is taking new patients.
You MAY want to consider the following:
- Does it matter to you if your doctor is a man or a woman?
- Do you want a doctor who is in a clinic, a hospital or a private office?
- Do you want a doctor who has evening and weekend hours?
- Where is the most convenient location for you to go to the doctor’s office?
- Do you want a doctor who speaks a language other than English?
- Do you want someone who is comfortable with LGBT people?
The easiest way to find a new doctor who is in your plan is to call your health plan. You can also use your health plan’s web site to search for a doctor. Either way, you should call the doctor’s office to make sure he or she is still “in your plan.” Take out your health insurance card and call the telephone number for member services or customer services. The member services person will ask you for the member ID number that is on your insurance card.
Special Note: The list of in-network providers in a health plan can sometimes change. It can be confusing and frustrating for you. It’s better to spend extra time on the phone with member services making sure your doctor is in-network. If you don’t, you could end up with a big bill from a doctor you saw who was out of network.
Deciding which doctor is right for you
The member services person may give you the names of several doctors. Call the first doctor’s office to confirm that he or she is still accepting your insurance. If you speak a language other than English, see if the doctor and staff speak your language. Pay attention to how you are treated by the staff over the phone. If you are not satisfied, try a different doctor’s office. Ask other questions. For example – Is the doctor in the office on any nights or weekends?
You can find out what patients think of the doctors on your list by looking up reviews online. Here is an example of a good online review of a doctor:
Another good idea is to ask your neighbors, friends or co-workers if they have been to any of the doctors on your list. Are they satisfied with the doctors?