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How To Choose A Specialist

Step 3. Locate A Specialist Who Fits Your Insurance and/or Finances

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Many insurance policies limit your choice of specialists. To locate a specialist that fits what you are looking for as well as your insurance situation, see  the appropriate section below. The suggestions about each different type of policy should help you locate a specialist who fits your needs in your area, and help you to narrow your choices. If you cannot find an appropriate specialist in your area, consider traveling to a medical center and seeing a specialist there to set and review your treatment. You can then take the treatment or drugs locally.

NOTE: Help is available to find a specialist. For example, Second Opinions Medical Information Services can help find specialists for particular needs. See www.physicians-background.com offsite link or call 850.862.5075.

IF YOU HAVE MANAGED CARE HEALTH INSURANCE such as an HMO, PPO or POS (a plan where you have to get approval before seeing a doctor, or are urged to see one of the plan's doctors

The health plan will provide a list of specialists from which to choose.

If a specialist you would like to consider is not on the list, ask the doctor's office if s/he would be willing to contract with your insurance carrier. If not, it could be helpful to you to learn why not. The answer may provide information to watch for with respect to the doctors who are on the plan.

If the doctor is willing to be on the list, speak with the insurance company and ask if the doctor could be put on their list. If the company says no, it may also be helpful to know why not.

IF YOU HAVE MEDICARE

Original Medicare (also known as "Old Medicare"): You can see any specialist who accepts Medicare. For a list of such specialists, see www.medicare.gov offsite link (click on Search Tools, then Find a Doctor).

If a specialist you would like to consider is no't on the list, ask the doctor's office if she or he would be willing to accept Medicare. The odds are the doctor has considered it, and rejected the idea - but it's worth a phone call. If the doctor is willing to be on the list, call Medicare at 800.MEDICARE.

Medicare Advantage: If you have a Medicare managed care health insurance plan, such as an HMOPPO or POS, the health plan will provide you a list of doctors from which to choose. 

If a specialist you would like to consider is not on the list, ask the doctor's office if she or he would be willing to join your insurance carrier. If not, it could be helpful to you to learn why not. It may provide you information to watch for with respect to the doctors who are on the plan.

If the doctor is willing to be on the list, speak with the insurance company and ask if the doctor could be put on their list. If the company says no, it may also be helpful to know why not.

IF YOU HAVE MEDICAID

If Medicaid pays for a private managed health care plan: If you have a managed care health insurance plan, such as an HMO, PPO or POS, the health plan will provide you a list of specialists from which to choose.

You may be limited to a choice of designated participating specialists or medical groups. Check your plan to obtain your choice of specialists.  If there are no specialists who can provide you with the quality of care that you require, you will likely have to advocate for yourself to see a specialist outside of the network plan.

If a specialist you'd like to consider isn't on the list, ask the doctor's office if she or he would be willing to join your insurance carrier. If not, it could be helpful to you to learn why not. It may provide you information to watch for with respect to the doctors who are on the plan. If the doctor is willing to be on the list, speak with the insurance company and ask if the doctor could be put on their list. If the company says no, it may also be helpful to know why not.

If you do not have a managed health care plan through Medicaid: To locate specialists who accept Medicaid, contact your local Medicaid Office.

If the offices does not have a list, locate doctors who accept Medicaid through one of the following:

  • Hospitals: Contact your local hospital, particularly community hospitals. The better the hospital, the better their doctors are likely to be. Ask to speak with one of their social workers.
  • Local disease specific non-profit organizations may know the names of doctors who accept Medicaid.
  • Support Groups and Self Help GroupsIf you are a member of a support group or a self help group, other members may have suggestions about doctors who accept Medicaid. 
  • Clergy: Your local religious organization will likely know the name of doctors who accept Medicaid.
  • Friends and Family: People in a situation similar to yours may have doctors to recommend.

IF YOU HAVE A PRIVATE FEE-FOR-SERVICE INSURANCE POLICY (also known as an Indemnity Policy)

Under a Private Fee-For-Service (Indemnity) Insurance Policy you have an unlimited choice of specialists.  See the next section: "Uninsured".

IF YOU DO NOT HAVE HEALTH INSURANCE ("Uninsured")

The following will help you find a specialist in your area who fits your needs. Once you locate doctors of interest, you can learn about how many times heor she performed a particular service and the average charges for those services at data.cms.gov offsite link (click on "Medicare Physician And Other Supplier Look-Up Tool")

Professional Groups

 If you are looking for a particular type of doctor, professional groups provide a helpful place to start:

  •  American Medical Association www.ama-assn.org offsite link 800-621.8335  click on "Doctor Finder"
  •  Oncologists: American Society of Clinical Oncologists www.asco.org offsite link
  • American Board of Medical Specialties: www.abms.org offsite link, allows you to search by specialty. The site is free but requires registration of your name and email address.

Health Professionals

Ask doctors, nurses or other healthcare professionals for the names of specialists who fit your criteria. They can often provide valuable "inside" information about the doctors as well. They may also be able to tell you which specialists to avoid.

Local Prestigious Hospitals or Large Teaching Hospitals in your Area:

  • If such a hospital is nearby:  Stop by and ask a nurse in the Emergency Room or in the Intensive Care Unit (ICU) or a hospitalist (a doctor who only works in a hospital) who she or he would use, and why. Think about saying something like: "I'm new to town. I have to choose a specialist who has privileges at this hospital, most ideally one who is particularly good at treating patients with (mention your diagnosis.)  I know all the doctors here are great, but I'd appreciate your telling me which specific specialist you would consider if you were me." 
  • If the hospital is not nearby: .Call their doctor referral service.  You will only receive a list of doctors who are affiliated with their hospital, but these types of facilities tend to attract the "cream of the crop." 

Local Medical School 

Contact the medical school located closest to you.  Explain the type of specialist that you are looking for and ask for recommendations.  Some instructors actually maintain their own medical practices and tend to be informed on the latest recommendations, procedures and treatments. 

Local Disease Specific Non-Profit Organizations/Support Groups

Both may be able to provide invaluable information about specialists because they come to the table with an insight with respect to your diagnosis and medical needs.      

Family and Friends

Consider asking family and friends whose opinions you trust for the names of specialists with whom they have had a successful relationship.  Keep in mind that even though friends or family members recommend a specialist, we recommend that you do your own research about the doctor. One person's experience with a particular doctor may be an exception.

The Internet

There are many easily accessible sites about specialists on the internet.  Unfortunately, there is no one-stop shopping. Check the websites listed in our document: How To Locate A Doctor Through The Internet 

These sites can help you compare the qualifications of specialists for which you already have names, or they can help you locate specialists who meet your criteria.  All services are free of charge except where noted. 

IF YOU NEED A DOCTOR WHO MAKES HOUSE CALLS

If you need a doctor who makes housecalls, see the website of the American Academy of Home Care Physicians (www.aahcp.org offsite link). It lists doctors and other health care providers by state and zip codes for the areas served.


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