All health plans come with a network of doctors and specialists, but not all plans offer access to the same doctors and specialists. When choosing a doctor, it’s important to find one who accepts your health plan and can get you the care you need so that you can put your health insurance to work.
What Does It Mean to Be “In-network”?
Your health insurance company works with certain hospitals, doctors, and specialists to get discounted rates on medical services. When a doctor is “in-network,” he or she belongs to a contracted group of providers. Some insurance plans will cover you if you visit a doctor outside your network, but that’s not always the case. When possible, visit a doctor that accepts your insurance plan. This will help you avoid the hassle of appeals and unexpected, expensive medical bills.
There are three types of insurance networks, each with their own rules about how you can use your plan. To see which network you have, check your insurance card.
- HMOs require you to stay in-network. You’ll also likely need a referral from your primary care provider to see a specialist.
- PPOs partially cover an out-of-network visit and don’t require referrals to see a specialist. This is the most popular plan type.
- EPOs require you to stay in network, but you don’t need a referral to see a specialist.
For more information on doctor networks, check out our complete guide.
Find a List of In-network Options
Now that you know your network type, it’s time to find a list of doctors who accept your health plan. Most insurance companies have a search tool that displays in-network physicians near you. We’ve include links to these tools for some common insurance companies; if you don’t see yours, simply Google “[insurance company] find a doctor.”
- BlueCross BlueShield
- Kaiser Permanente
INSIDE TIP: some third-party tools like ZocDoc or Healthgrades help you find and schedule appointments with in-network doctors. Note: these tools receive a commission from the doctor when you book an appointment, so you won’t necessarily see all of your in-network options.
5 Things to Consider When Choosing Your Doctor
Now that you’ve found a list of in-network options, it’s time to talk about choosing a doctor. Go through our five-step checklist to find the one that best suits you.
- Are they really in-network?
Just because your health insurance company lists a physician as in-network, there’s a chance that may no longer be the case. The world of health insurance is a complicated place and doctors often change networks without updating their information. You can verify that they’ll take your plan by calling their office and asking if the specific doctor you are interested in is accepting your specific insurance plan.
- Is the doctor accepting new patients?
Sometimes, a busy specialist or primary care office will not accept new patients. When you call an office to determine if its provider is in-network, be sure to also ask about their availability for new patients, specifically as it relates to the doctor you are interested in.
- Can I book the appointments I need?
It’s important to screen your options when choosing a doctor to make sure their office hours and availability match your lifestyle. If you work full-time and need care often, a doctor with limited hours and full schedules won’t be an ideal fit. Feel free to call potential providers’ offices and ask questions such as:
- How long does it take to get an appointment?
- How long do you usually have to wait in-office for your actual appointment?
- Are appointments only Monday through Friday?
- How far away is their office?
Do a quick search on Google maps to make sure the doctor is within reasonable travel distance from your home or work. Sometimes, specialists will work in multiple facilities (not all of which will take your insurance), so be sure to search for the right clinic.
- Do people like him/her as a doctor?
A provider with poor bedside manner won’t offer the care you need, even if they’re in-network. We suggest doing a quick Google search of the doctor’s name, which will usually yield Yelp or Google reviews from other patients; you could also search for reviews on sites like Web MD and Healthgrades. Reviews can be misleading, so look for moderate feedback that discusses the relevant issues you care most about (empathy, time spent in the waiting room, etc.).