Choosing A Health Care Provider
- Written by Ann Dennison Ann Dennison
- Published: 22 January 2014 22 January 2014
Most of us research a new car, television or appliance when we need or want a new one, but how much time do we put into choosing a health care provider when we need or want a new one?
I thought I would provide an opinion of how to choose a health care provider since some of you may be faced with having to choose a new provider if you’ve changed insurance companies. I believe it is important to consider a few factors including who the provider works for, whether or not the provider participates with your insurance, practice location, any special certifications that the provider may have, helpfulness of office staff, and recommendations of friends/ family.
In the current health care environment, many providers have chosen to work for a hospital system rather than remaining independent. Reasons for joining a hospital system or an ACO (Accountable Care Organization) include declining reimbursements to providers, cost of overhead, increasing regulation of the “business” aspect of being a medical provider, and malpractice insurance costs. Whatever the reason, I like to know if my provider will choose the best specialist for me if needed, or if I will only be referred to someone within the same system. Providers are being asked to sign contracts in which they must guarantee a certain percentage of referrals into the system where they are employed. I personally want my provider to recommend the best specialist for my particular condition. There are also insurers and health systems that have made arrangements to offer insurance plans to businesses and individuals that make the deductibles and copays so high to go to a provider in another system that they virtually guarantee that subscribers will stay within that system for all of their care.
Most insurance companies list participating providers on their websites and many providers will list the insurance companies with which they participate on their practice websites as well. At the very least, when you call the provider’s office, they should be able to tell you if the provider participates with your particular insurance. For instance, some providers will not accept auto insurance or worker’s compensation insurance. At the very least, I like my primary care provider to be participating with my insurance, so that hopefully, my out of pocket costs for routine care will be lower.
Location may or may not be important, depending on your ability to access any specific location. For those who do not drive, a location near a public transportation access point would be important, or for those that do not like highway driving, a provider whose office is located nearby would be important.
I personally find it helpful to know any special certifications my providers have. Board certifications or fellowships beyond licensure indicate advanced knowledge and skill. Some examples include fellowships (in the American College of Surgeons, Family Physicians or Orthopedic Surgeons), board certification (in his/her specific specialty, such as plastic surgery, orthopedic physical therapy and many more). Membership in professional organizations often requires higher ethical standards of their members.
I am always “put off” by unfriendly staff that make you feel like you are a burden to their work day and would not choose to frequent an office that made me feel that way. I believe the office staff should be there to assist not only the provider, but also you, the patient.
Recommendations from friends and family, especially any that may work in the medical field, can be invaluable. Your friends and family will have an idea of how well you would appreciate the personality or style of the provider in question. Some providers are very business-like and to the point, while others are more apt to become more personally familiar with their patients. Friends or family are likely to share both their good and bad experiences with you honestly.
Choosing a health care provider should warrant at least as much thought as purchasing a new car since your life is in their hands. Now that I’ve given you my suggestions, I would be interested in hearing other recommendations or ideas of how you choose your health care providers, so please feel free to leave any suggestions. As always, thank you for reading and stay active!