Choosing a Doctor: How to Get the Highest Value

Know what to look for when picking a doctor, and don't forget that the type of insurance you have can affect your choices.

Apr 20, 2014 at 1:30PM

Choosing a new doctor can be complicated, especially if you've recently moved to a new community or changed insurance plans. Asking friends, relatives, coworkers, and neighbors for recommendations is a common way to start your search, but ultimately others may not be able to tell you which doctor best suits your needs.

Following are some steps you can take to ensure you choose the best doctor for you.

Check out your network
It's important to understand the basics about different types of health insurance plans to know which doctors are available to you for the best rates. Different health plans offer different levels of flexibility and cover different amounts for in-network and out-of-network doctor's costs. Usually, to save money on doctor's visits, you'll want to choose a doctor in your network.

  • Health Maintenance Organization, or HMO: HMOs usually enable participants to have lower out-of-pocket health care costs, but offer less flexibility in your choice of doctors or hospitals in comparison with other health insurance programs. HMOs typically offer no coverage for services rendered by doctors who are out-of-network and require you to get referrals to specialists from your primary care provider, or PCP. The exception for this rule is for referral to an OB/GYN: The Affordable Care Act allows you to self-refer to an OB/GYN without needing to go through your PCP.
  • Preferred Provider Organization, or PPO: With a PPO, it behooves you to use your carrier's network of approved doctors and hospitals, because these doctors have been contracted to provide you services at a discounted rate. PPOs let you choose a doctor outside their network, but those doctor visits will cost more than those to in-network doctors.
  • Point of Service: Point-of-service plans are similar to both HMOs and PPOs. In some cases, you're required to designate a primary care doctor who can refer you to specialists. As with PPOs, you can get care from out-of-network providers but for greater costs.
  • Indemnity plans (also called "fee-for-service" plans): Indemnity plans allow you to manage your own medical care more freely. With an indemnity plan, you can see almost any doctor or visit any hospital you want. The insurance carrier pays a set percentage of your charges (usually based on what local providers charge for the same service), and you may be required to pay upfront and receive a reimbursement.

If you don't have health insurance, you'll have to pay out of pocket for visits to the doctor, to urgent care, or to the emergency room. Furthermore, you may face a penalty for not abiding by the Affordable Care Act. The fee is called the "individual shared responsibility payment," and this Obamacare penalty may cost you thousands in coming years.

Determine what you want
It's a good rule of thumb to find a PCP before looking for a specialist. A trusted PCP can manage your overall well-being and refer you to a specialist if necessary. PCPs are often well connected to the health-care community and local hospitals, and they can recommend you to specialists who will better meet your needs.

There are many factors you should consider before choosing your PCP. Are you looking for a family doctor, or a doctor for yourself? Do you want a doctor you can visit close to work or close to home? How accessible would you like your doctor to be via email or phone? Are you more comfortable with a male or female doctor? The answers to these questions will help you narrow your search.

Investigate what they offer
Most insurance providers have a website you can use to search for a local doctor who accepts your insurance. If you prefer not to search online, you can call your insurance provider to ask for a list of local doctors who take your insurance plan. After you have some prospects in mind, call their offices to get more information. Important questions to ask include:

  • Is the doctor currently taking new patients, and does he or she take your insurance?
  • How long will it take to get an appointment, and what is the average length of an office visit? Does he or she make evening or weekend appointments?
  • If you have an urgent need, can he or she see you on the same day you call?
  • Does he or she handle insurance claims at the office? If not, you may have to pay for services up front and file the claims on your own, which can be inconvenient.
  • Which hospital does your chosen doctor use?
  • Can you get X-rays done in the office, or do you have to go to a hospital?
  • What is the policy for canceling appointments?
  • If you're dealing with a particular medical condition, does he or she have experience treating it?

Reflect on your first appointment
There's no need to feel obligated to stick with a doctor after the first visit. Before you decide to return, evaluate the following:

  • The waiting room: Was the office staff courteous, and how crowded was the waiting area? Did the other patients seem satisfied with their care?
  • The doctor: Did the doctor spend enough time with you? Did he or she give you the chance to ask questions -- and take the time to answer them thoroughly?

There are many websites and organizations that are here to help choose the best doctor for you. To research the quality of care at hospitals, check out the federal government's Hospital Compare Website. To learn if a doctor is in good standing with state licensing agencies, visit the Administrators In Medicine site. You can also choose doctors, read reviews, browse by specialties, and more at Medicare's Physician Compare.

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