Finding a doctor who is a right fit for you is much like other things in life. You would never think of buying a pair of shoes that don’t fit, than why not invest a bit of time and effort in shopping or finding a doctor. When you buy a car you research, compare features, do price comparisons, look at safety stats and eventually settle on one that checks off all the boxes. Looking for a doctor is much like looking for a lawyer or accountant, but the obvious difference in finding a physician is you are entrusting your life to him or her. We all rely on family, friends or co-workers for suggestions and recommendations. And this is absolutely a logical and good start, but a few simple steps and suggestions can make this often difficult decision more manageable.
When looking for a physician there are a key things to consider that will help navigate this process. To put it simply in California people fall into roughly four categories. Private Insurance which can be either through an employer or individual and can be a PPO (Preferred Provider Organization) or HMO (Health Maintenance Organization. PPO plans typically cost more and give the insured more flexibility and options in finding doctors and hospital care. You don’t need a primary care physician and for the most part can go to any health care professional. In an HMO plan the insured is required to pick a primary care doctor, and all your health care services go through that doctor. This means that anytime you need to see a different health care professional you will need a referral. Both these systems use a network of physicians, hospitals and other professionals. PPO plans for this reason cost more than HMO plans. Then there is the federally funded program for seniors and retirees known as Medicare and the state funded income based program commonly known as Medical or Medicaid. The Affordable Care Act which is synonymously known as Obamacare is called Covered California.
Covered California is where Californians who previously did not have insurance can get health insurance under the Affordable Care Act. Some people can qualify for premium assistance to help buy private insurance while others may get insurance through the state’s Medi-Cal program. Most insurances will have yearly open enrollment when people can either enroll or make changes to their plans. This open enrollment is typically from November thru January. Vision and dental plans are usually separate and not always a covered service of your health insurance plan.
When looking for a doctor, a good start would be calling your insurance to check which doctors are on your network. According to recent statistics one third of Americans either do not have a primary care doctor or believe they do not require one. Having a primary care physician simplifies regular care, and the patient is able to see a doctor with a shorter appointment time. Additionally the primary care doctor follows and monitors routine health concerns, and should someone find themselves in a serious health crisis the primary care physician is familiar and aware of that person’s health status. There are a few pertinent and relevant suggestions that one can follow to find a doctor.Determine what kind of doctor you need: If you have a heart problem you will need a cardiologist, if you have stomach issues a gastroenterologist is who you would look for. But if you have just need a doctor to monitor blood pressure or diabetes you can look for a family physician or internal medicine doctor or if you don’t know who you need a primary care doctor is a good starting point. The American Board of Medical Specialties requires the doctors to maintain certification in their specialty. To see if the doctor is certified go to certificationmatters.org.
Each state has its Medical Board and anyone can check if the doctor they are considering has any malpractice claims or disciplinary actions against him. In California the site is mbc.ca.gov to verify a license.
Ask or research the doctors hospital affiliations, education, specialty, the languages spoken , years in practice , what insurances the office accepts and if they are accepting new patients. You can see a doctor if he or she don’t take your insurance but be aware that you may have to pay more. It’s a good idea to call your insurance if you plan on seeing a new doctor and ask the insurance company if that particular doctor is part of their network.
Check Board Certification: The medical license allows a doctor to practice medicine but to be recognized as a specialist in a particular field they need special certification and will require regular continued medical education. This is an additional step that tells you that the doctor has had extra training in the field that they are certified in.
Co-payments are established and based on the type of plan you may have: Co-payments are collected at the beginning of the appointment and the patient is responsible for it. The office should bill the insurance and once the insurance pays they will bill you for the rest based on your plan.
Compatibility and Personality: You may need to see the doctor at least once to establish if the doctor listens to your concerns, is able to answer questions in a way that the patient understands and that the doctor takes the time to explain the diagnosis and treatment.
Office Policies: Ask questions of the staff, how long do typically have to wait for a routine appointment. Billing procedures for patient and insurances should be clarified. For cash paying customers who are willing to pay their bill at the time that services are provided, some doctors will offer a discount. Pay attention to the staff, are they friendly, efficient and professional. HIPAA (Health Insurance Portability and Accountability Act) requires the protection and confidential handling of your health information. Your privacy should be protected. Additionally patients have a right to their medical information and can request copies if they want for whatever reason.
Check various different organizations like AMA Dr Finder, Healthgrades.com, National Commission for Quality Assurance, Vitals.com, RateMD’s.com or talk to your insurance company. While National Comm for Quality Assurance is largely based on self-reporting the others have reviews and comments from other patients which may prove helpful for you. Check the doctor’s site if he/she has one.
Remember that you are an equal and very important partner in your health and should be involved with your care. Feel free to ask questions, if you are getting a procedure done it is relevant and important to ask the doctor how many of those procedures he/she has done before. You should ask about the risks and benefits and ask for clear instructions. Most importantly trust your instinct and make your doctor an integral part of your wellness and health.