Understanding Medical Insurance Terminology

« Back to Home

4 Considerations When Choosing Your Primary Care Provider

Posted on

When you purchase your first health insurance plan or are switching insurance, your first hurdle is selecting a primary care provider (PCP) within your network. There are several qualities that can make one provider more helpful than the next.

Look At Your Overall Network

The best way to narrow your list of potential PCPs is to consider the overall network for your health insurance. There may be certain hospitals or medical groups that are more prevalent within your network. You will likely want to pick a PCP who works with a health system that has many specialists and accessible medical facilities for hospitalization or outpatient procedures. This can keep your co-pays lower and make it easier if you need a referral to a specialist in the future. Some medical specialties are less common than others, such as sports medicine, rheumatology, nephrology, or nuclear medicine. Although you may never need these specialties, it helps if they are not out-of-network.

Choose A Versatile PCP

If possible, try to call different doctor's offices and ask about various providers or find out if any additional information is available on their website. Since you may have any number of medical concerns, it helps if your PCP is more engaged with your care, instead of referring you out. For example, many PCPs are willing to do cortisone injects, cyst removals, and other simple procedures but not all do even if they know how. Simple procedures will put less of a dent in your wallet if they can be done by your PCP instead of requiring a referral to orthopedics or dermatology.

Consider Your PCPs Colleagues

The other medical professionals who work with your PCP can be equally as important. Many doctors also have nurse practitioners or physician's assistants who work closely with them and meet with patients. If you do not have a pressing concern and only need to make an appointment to refill prescriptions or have blood pressure checks, it makes little sense to pay co-payments associated with a full visit. Some insurances charge lower co-payments depending on the practitioner you see or for medication checks.

Find Additional Clinical Features

Another attractive feature for some medical clinics is any diagnostic imaging or laboratory work that can be done on-site. This makes it easier to have tests performed without additional traveling or other inconveniences. Your insurance provider may treat testing differently if they can be performed at your doctor's office versus the need to go to an outpatient facility. When possible, this should be an important quality that can make one provider a better option than the next.

When choosing your PCP there are many considerations that can influence your decision. Ideally, the doctor you choose should make it easier for you to access any number of services you may need in the future. For more information, contact an internal medicine clinic, such as Broadway Medical Clinic, LLP.


Share