You have health insurance, so when it’s time for your next medical visit, all you need to do is find a doctor who takes your insurance, right? Sadly, it’s not so simple.
To illustrate how complicated this can be in the U.S., consider the story of Michael Trost. As reported by public media organization WHYY, when Michael needed open heart surgery, he made sure to go to a hospital that was in his insurance network. But after the operation, he was blindsided by a bill for $32,325 because the cardiologist—unbeknownst to him—was out of network.
“I guess in my naive view of health insurance, I had felt that because we were in network, that everything would be taken care of,” Michael’s wife, Susan Rosalsky, told WHYY.
Michael and Susan are not alone. Many people do not understand how insurance works or how to find a doctor that takes their insurance.
Below, we’re going to demystify the process so you can find the right doctor for you and save as much money as possible on your healthcare.
How to find a good doctor that takes your insurance: 6 crucial steps
1. Start your search with MediFind for accurate doctor information gathered into one place.
You deserve the best, and that includes healthcare. This is especially true if you have a serious, complex, or rare illness. Finding a doctor should be more than just a “well, I was stuck with this provider because they took my insurance.” We built MediFind for you.
With MediFind, you can search for doctors by condition, not just specialty. So if you have Graves’ Disease, for example, you’re not limited by searching for endocrinologists in your area. Using our Find a Doctor feature, you can locate endocrinologists with real-world expertise and clinical research in Graves’ Disease—helping you get the best care.
When you conduct a Find a Doctor search on MediFind, you’ll get a list of the top 20 specialists in your condition in your area, labeled by their clinical expertise from Experienced to Advanced to Distinguished to Elite. MediFind takes into account many factors—including research portfolio, patient and referral volume, and participation in clinical trials—to determine this tier for each specialist.
From there, you can click each profile to read more about the doctor and get a brief overview of the insurance the provider accepts. While we strive to provide accurate information, you must call their office to verify that they are in network with your health plan (we include their phone number).
Using MediFind, you can make a much more informed decision about the best doctor for you in a faster time frame. Then, you can take the following steps to check if they are in network with your health plan.
2. Change your wording to “doctor that is in-network with my insurance.”
Calling a doctor’s office and asking, “Do you take my insurance?” is risky because while a doctor might accept your insurance, that does not mean they are in network with your insurance.
What’s the difference?
In network means the provider has a contract with your insurance company that ensures discounted pricing for members of that health plan, meaning your out-of-pocket costs (if any) will be lower than with an out-of-network provider.
Out of network means the provider does not have a contract with your insurance company. So even though your health plan may cover some of the visit costs, your out-of-pocket costs will probably be higher than with an in-network provider.
3. Check your insurance provider’s website.
Most insurance provider websites have a “Find a Doctor” function where you can search for a healthcare provider’s name to check if they’re in network with your health plan. However, even this information can sometimes be inaccurate, so it is always recommended to call the doctor directly to check your coverage.
4. Call your insurance provider.
In addition to checking the website, call the customer service line of your health insurance provider. You can talk to a real human who can search the database for a specific type of provider or specific name of a provider and ensure that they are in-network.
5. Cross-check by calling your desired doctor and asking if they are in-network with your insurance plan.
We know, we know: This may seem redundant or excessive. But when it comes to healthcare coverage, it’s always best to be thorough and check as many sources as possible. Even if you have confirmed with your insurance provider that the doctor is in-network with your plan through their website and a phone call—it’s still a good idea to give the doctor’s office a call to verify that they are in-network.
6. Sometimes it’s more than just one doctor who needs to be in-network.
Unfortunately, there are many situations where you’ll need to check more than just one doctor to ensure all the care you’re getting is in network. For example, your doctor might be in network, but the lab they order your tests from might not be. In a case like this, contact your health insurance company and find out which labs are in-network and have the doctor submit lab requests to a specific facility.
As you saw from Michael and Susan’s story, this gets especially complicated if you need surgery. Surgeries involve so much more than just one doctor, so to avoid a surprise bill, you’ll likely need to ask about the surgeon, the hospital, the anesthesiologist, the radiologist, and any other provider or facility that will offer care during or after the surgery.
How do I choose the right provider? How do I know if my doctor is good?
Choosing the right provider for you is a highly personal and important decision that shouldn’t be made lightly. And you may need to try different doctors before you find one you love.
Questions to ask yourself
What are the most important factors to me when choosing a doctor?
Some patients really prioritize bedside manner, while others care more about clinical expertise. It’s crucial to decide what matters most to you.
Can I afford this doctor in the long run?
Sometimes you find a great doctor—but they’re out of network. If that’s the case, check your health plan and give your insurance provider a call. Much of the time, out-of-network providers still receive some coverage from your insurance, so even though it may cost more overall than an in-network provider, it may still be worth it to you if you really love that provider.
Additionally, during annual open enrollment when you can change health insurance plans, you may consider choosing a plan in which your preferred provider is in network.
How easy is it to access this doctor?
Try to determine how often you’ll need to schedule visits with your provider. If they’re located far away, do they offer telehealth visits as a more convenient option? Also, consider how far in advance you need to book. Some popular specialists book out months in advance, so if you need to see them more frequently and urgently, this may be a dealbreaker for you.
Does this doctor’s office have the technology that’s important to me?
For example, you may prefer the open environment of Cone Beam CT scans because traditional CT scans where you lie down in a tube make you feel claustrophobic. Or you might want a doctor who offers online appointment booking for your convenience. Inquiring about these things is part of patient autonomy and can help you make the most informed decision about your care.
Does this provider have the clinical expertise for my specific health conditions?
There may be 50 endocrinologists in your area, but if you’re living with Graves’ Disease, you’re probably most interested in a specialist who has extensive experience treating patients with this condition and keeps up-to-date on the latest research and clinical trials for Graves’ Disease. In fact, 55% of people living with a rare disease rated clinical expertise as the most important factor in choosing a doctor.
In situations like this, online reviews and recommendations from friends are typically of little use. You’ll need a resource built specifically for this use case, which is exactly what MediFind is. Using machine learning and a team of medical experts, MediFind sources the best and most accurate information—including recent clinical research each doctor has participated in—so you can make the best decision about which specialist to choose.
Can I trust online review sites or recommendations from loved ones?
While it’s common to ask friends and family or scour online reviews to find a good doctor, here’s why that might not be sufficient:
- Online review sites can be biased. Research has shown that online reviews can be biased against women doctors among other biases. Additionally, a study found that patients are most likely to leave reviews about their most extreme negative cases, and less likely to leave reviews when things go well. What you see in online reviews doesn’t necessarily tell the whole story of a physician, such as their board certifications, areas of expertise, or clinical research.
- Your friends and family are probably not medical experts. Your friends and family love you, and they’re great! But most likely, they’re not medical experts. If you ask your sister for a recommendation for a good dermatologist, she might rave about her skin doctor because he’s friendly and conveniently located. But that doesn’t necessarily mean this dermatologist will provide the quality of care you’re looking for. If you do want to ask friends and family, be specific about what your needs are.
- Your loved ones don’t know all the details of your unique health history. If your Aunt Linda saw a rheumatologist for her arthritis, but you’re seeking one for lupus, Aunt Linda’s glowing review of this specialist’s expertise might not be applicable to you.
How to find in-network doctors (by insurance company)
To make it easier for you, we’ve compiled a list of major health insurance companies and information on how to find in-network doctors if you’re a member of one of their health plans.
Aetna
Customer service for non-Medicare plans: 1-888-632-3862
Blue Cross Blue Shield
Cigna
Medical coverage questions: 1 (800) 244-6224
Humana
Medicare: 1-800-457-4708
Insurance through employers: 1-800-448-6262
Kaiser Permanente
Medicare
1-800-633-4227
UnitedHealthcare
Customer service for members who have health insurance through work: 1-866-414-1959
What to do if you thought your doctor was in-network, but you got a surprise bill
Despite your best-laid plans and thorough due diligence, you still might wind up with a bill you can’t afford to pay. That’s one of the unfortunate things about the U.S. healthcare system.
As we talked about before, an unexpected medical bill can happen when a hospital is in-network but the doctor is not. Especially in emergency situations, consumers can find themselves faced with a huge bill for out-of-network care they didn’t know they were choosing. This is known as surprise billing, and in January 2022, a federal law went into effect to protect patients from this.
The No Surprises Act (NSA) bans:
- Surprise bills from emergency services you receive, including services provided out of network and without prior authorization.
- Out-of-network cost-sharing for all emergency and some non-emergency services. Examples of cost-sharing include copayments and coinsurance.
- Out-of-network charges and balance bills from out-of-network providers who give supplemental care in certain in-network facilities. An example of this would be an out-of-network anesthesiologist at an in-network hospital.
If you’re hit with a higher-than-expected medical bill, familiarize yourself with your rights under this new law.
Even if your bill is not covered by the No Surprises Act, you should still scrutinize the bill for any coding errors (more common than you’d think!), or call the healthcare provider and your insurance company and try to negotiate the bill.
Finding the right doctor should be fast and easy
That’s the entire premise that MediFind was built upon. Our founder, Patrick Howie, came up with the idea for MediFind after his brother was diagnosed with a semi-rare cancer. Not being able to quickly find information about specialists and clinical trials hindered his brother’s ability to find the right care.
Not anymore. We’re connecting patients like you with the information you need to make the most informed decisions about your healthcare, whether that’s finding a good doctor that takes your insurance or locating a clinical trial that you qualify for. Find the right doctor for you today.
