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Finding a New In-Network Doctor

Helping Employees Find the Right Doctors

Access to the right health care providers is key to your employees’ getting high-quality care and to managing their out-of-pocket costs and your bottom line.

When employees need to choose a new doctor for themselves or family members, they will want to be confident they are making the right choice. That may seem like a daunting task — especially if they are new to an area or their doctor is no longer in their health plan’s network. Here are some tips to help them.

Start With the Health Plan

Most health plans have negotiated special, discounted rates with the doctors and hospitals in their plan’s network, so members will pay less — and so will you — when they receive care from these “in-network” providers. But selecting the right health care provider requires more than viewing a list of names. It takes information on everything from credentials and quality ratings to office hours and locations. Today’s health insurers make this information available to their members online, by phone and in person.

Encourage Your Employees to First Choose a PCP

While a health plan may not require their members to select an in-network primary care physician (PCP), you may want to encourage your employees to choose one. The PCP may help with managing costs and help to ensure that your employees get the care they need.

In addition to treating non-emergency illnesses, the PCP can encourage your employees to get preventive care to stay well and help them manage health conditions. They’re also a great resource for coordinating care with other in-network providers and finding the right specialists, when needed.

  • The Member Website
    Although customer service representatives can help your employees with finding in-network doctors, a wealth of information is at their fingertips through the plan’s member website, which they can use anytime. Online “Find a Doctor” tools are much like any other online search engine. The member simply begins by choosing a medical specialty and entering a location, either by ZIP code or city and state.Once your employees have identified potential doctors, they can refine their search by reviewing information, such as:

    • Credentials and board certification
    • Office locations
    • Hospital affiliation
    • Facility hours
    • Doctor’s gender
    • Languages spoken
    • Accepting new patients
    • Office policies

    While board certification is one of the best indicators of competency and training, employees can also look for other quality indicators. The plan’s website may include patient satisfaction reviews or use more criteria-based distinctions.

    A highly rated hospital can dramatically lower a patient’s risk of complications. Employees who want to consider a doctor’s hospital affiliation may want to visit carechex.com. A division of Comparion® Medical Analytics, CareChex® specializes in rating and ranking the quality of hospital and physician care using both public and proprietary measures of performance, including process of care, outcomes of care and patient satisfaction.

  • Customer Service
    Employees who prefer to get assistance by phone may consider using the plan’s customer service option. In addition to helping their members find providers, representatives may also assist with scheduling appointments and transferring medical records.
  • In-Person Events
    Special face-to-face events, such as open houses that showcase new doctors, physician-led health presentations or “Meet Dr. Right” programs, give your employees the opportunity to talk with a variety of doctors to see if they are right for them before scheduling an appointment.

Other Online Search Tools

A variety of other online resources can help your employees find doctors outside your health plan’s network or learn more about the in-network providers. Here are a few to consider:

apps.ama-assn.org/doctorfinder
The American Medical Association’s Doctor Finder offers information on more than 814,000 physicians in the U.S., including physician education, specialty training, board certification and licensure.

healthgrades.com
This site allows searches by name, procedure, specialty or condition. It includes information on education, affiliated hospitals (and ratings on the hospital itself), sanctions, malpractice claims and board actions, office locations, and insurance plans.

medicare.gov/physiciancompare
Employees who are looking for health care providers who accept Medicare may find this site helpful. It includes information on board certification, education, practice information, group and hospital affiliations, etc.

recognition.ncqa.org
The National Committee for Quality Assurance (NCQA) helps individuals find doctors who have demonstrated that they meet important standards of care.

ratemds.com
This site allows searches by the doctor’s name, gender, ZIP code, state and specialty. It includes information on training as well as patient ratings on staff, punctuality, helpfulness and knowledge. It has links to medical board records to find disciplinary actions. Patients can post questions and answers about doctors.

www.vitals.com
This site allows searches by specialty, condition, insurance, name, etc. It includes information about a doctor’s awards, expertise, hospital affiliations and insurance, as well as patient ratings and comments.