Regular visits to your primary care physician provide essential preventative care that helps you stay healthy. However, you sometimes need to see a heart, diabetes or surgery specialist. Do you know where to turn? Learn how to choose a medical specialist who accepts your insurance as you reduce expenses and improve your health.
Steps to find a medical specialist
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Ask your primary care physician for referrals
Your primary care physician is an excellent resource when you need a reputable, experienced and trusted specialist. Ask for a list of suggested specialists who can handle your unique needs.
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Read your policy
Many insurance policies include details about covered services, including specialists, so inspect the paper or online copy of your policy. Look for the specialists your physician recommended or search for doctors who practice near your home or office. See Insurance guidance: agents, business value, medical specialists, and life coverage for related information.
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Call your insurance company
Your insurance customer service representative can help you find a covered specialist. You can ask your agent or call the insurer's help line and provide the specialist type, preferred location, or names recommended by your primary care physician.
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Call the specialist
If you know exactly which specialist you want to see, call the office directly. The front desk staff can usually advise you on whether the specialist accepts your specific insurance and what paperwork or referrals are required.
General tips to consider when choosing a specialist
- Verify board certification. Ideally, the specialist should have completed a residency and passed a competency test in the field.
- Check for good standing. State medical board resources provide details on a specialist's license status and any disciplinary history.
- Ask about payment details. Even with coverage, copays, imaging, lab tests and deductibles can be costly; some specialists may require payment in advance. Discuss costs and payment arrangements before your first appointment.
A specialist provides advanced medical treatment and care and is an invaluable part of your overall health. Be sure the specialist you need to see is covered by your insurance before you schedule your next appointment.
If you change jobs, move, or switch insurance companies, consider plans and stop-loss options that help protect against surprise medical costs; for one resource, see Medical Stop Loss Insurance.
Frequently Asked Questions
How do I confirm a specialist accepts my insurance?
Call the specialist's office and provide your insurer name and plan; you can also confirm by calling your insurer's member services.
Do I always need a referral from my primary care doctor?
It depends on your plan; some plans require a referral for specialist visits while others allow direct access, so check your policy or ask your insurer.
What should I ask about before my first specialist visit?
Ask about insurance acceptance, expected out-of-pocket costs, required tests or paperwork, and whether the specialist has admitting privileges at a nearby hospital.