You're covered; now, find the right doctor

PAUL LACHINE
PAUL LACHINE
Posted: January 05, 2014

Three, two, one - happy health insurance.

OK, so no one yelled that at the stroke of midnight Wednesday. But if someone had, it would have been understandable. After all, for many of the more than a million Americans who signed up on healthcare.gov by Dec. 24 - including tens of thousands of Pennsylvania and New Jersey residents - the new year heralded health insurance coverage.

"I can see the light at the end of the tunnel," Ken Lyle said two weeks ago as he signed up for a silver-tier plan through the Independence Blue Cross Express in Haverford.

Uninsured for the last two years, Lyle, 41, of Schwenksville, could not afford treatment for injuries he suffered in a 2011 car accident. That was, until Jan. 1. "Now I can get taken care of," he said.

Before Lyle and others can use their new plans, they must find a doctor. Many people will likely go about the task the old-fashioned way, asking relatives and friends for a referral. Others will rely on their insurers for help.

"The first thing people do is check with their insurer," said Chuck Moran, public relations director for the Pennsylvania Medical Society.

That's a good place to start, because insurers list online the doctors who are part of their networks. Independence Blue Cross has more than 12,000 participating doctor groups on its website; Horizon Blue Cross and Blue Shield of New Jersey has 8,000 primary-care practitioners in its network.

Most of the area's major hospitals also have "Find a Doctor" directories online.

Still, getting the right doctor/patient match requires asking questions and spending a few dollars. Before beginning your quest, it will help if you understand who is a primary caregiver.

"In our region, I would list family physicians, general internists, obstetrics and gynecologists, and, of course, pediatricians, who are primary-care doctors for children," said David Nash dean of the Thomas Jefferson School of Population Health. "We think of primary care as those four groups."

The first thing you should do once you've zeroed in on a primary-care doc is a basic background check. Go online to see when and from which medical school he or she graduated. How long has the physician been in practice? What is the hospital affiliation and with whom does he or she have admitting privileges?

Also look for board certifications. "The top of my checklist would be, 'Does the doctor have the appropriate credentials like board certification?' " Nash said. "Not all family physicians are board-certified and not all internists are board-certified."

The next step is to make an appointment to meet with the doctor or doctors you're interested in. Make it clear when you call that you are coming in to interview the doctor about becoming your physician, Nash said.

"Any practice unwilling to undergo a patient interview is a place that I would not want to be a patient," Nash said.

Once the meeting is arranged, write down your questions; be on time and ready and willing to pay.

"Ask detailed questions like, 'What are the office hours?' and, 'Does the practice have what we call ready access?' " Nash said. "In other words, if you call that morning and you are very sick, can you be seen that day? That is a very important thing. Many practices will say, 'Oh, no, you can't get in here for two or three months. Even in an urgent situation, we send patients to the emergency room.' That's a red flag."

Also ask who covers the practice when the doctor is on vacation, at nights, or on weekends, and how you contact those people in an emergency. Other potential questions: Does the office have electronic medical records? Does the doctor e-mail with patients?

"In a very sophisticated medical practice, I would even ask if I can have access to my own medical records," Nash said.

Finally, ask if the practice is a National Committee for Quality Assurance-certified Patient Centered Medical Home. The medical home is a concept that coordinates care across a practice and is growing in popularity.

"There are a modest number of patient-centered medical homes in our region," Nash said. "Those are going to become, in my view, a critical criterion."


Robert Calandra can be reached at 215-836-0101 or RTCaca@verizon.net.

This article was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente.

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