If you switched health plans this plan year, you may be on the lookout for a new health care provider. To find out what questions people should ask when shopping around for new doctors and specialists, A&M Systemwide spoke with Dr. Carol A. Rice, professor and health specialist with Texas Cooperative Extension.
What are the most important things a person should consider when
selecting a health care provider?
Is this provider covered by your health plan? If the provider is covered, is
he/she taking new patients? Is coverage limited because the provider is not
a preferred provider? What hospitals does the doctor use? Are these covered
by your health plan?
Most plans require patients to have a primary care physician. Family, internal medicine and pediatrician are usually those physicians considered to be primary care. [Editor’s note: See below for list of PCPs for each A&M System health plan.] Primary care physicians should be board certified. Most insurance providers require referral to specialists (like a dermatologist or endocrinologist) by a primary care physician.
Find out who takes calls if immediate help is needed or in an emergency or on weekends and holidays. Will the doctor answer e-mail or phone questions?
How long would you have to wait for a routine visit or for a check up? Does the provider have nurse practitioners or a physician’s assistant? This could reduce the wait for appointments. Will you be charged for a canceled appointment? Will the office complete insurance claim forms for you?
After your first visit, decide if the doctor listens to what you say, welcomes or discourages questions, gives you understandable instructions, spends adequate time with you, and seems to relate well to you.
What resources are available that can help people make informed
decisions when it comes to choosing providers?
Most health plans will provide a booklet or online list of physicians and other
providers within the plan. These usually provide brief descriptions of the
doctors’ training.
Establishing strong relationships with our doctors is very important.
What tips can you offer a person who is about to visit a doctor for the
first time?
Bring a complete list of your medicines, including the over-the-counter ones.
Include dosages and why you are taking each one. Bring a list of allergies,
past significant illnesses, surgeries and major accidental injuries, and dates
of your last regular check up, tests (such as mammograms) and immunizations.
Bring a list describing your family medical history, and provide contact information
for your last health care provider in case medical records are needed.
If you are coming for a specific reason, state your main problem first in one concise sentence. Writing it down can help. Describe symptoms, including when they started. Pain—dull ache or sharp pain? Vital signs you have measured at home like temperature, blood pressure, pulse, respirations. Have you had the problem before? What did you do for it, and did it help or make it worse? Any changes in your life (stresses, medicines, etc.)? Does anyone else at home have similar symptoms?
Finally, bring a written list of your questions regarding the problem you are having.
This information is provided as a service by the Texas Cooperative Extension.
Under the A&M Care, Scott & White, Mercy and UniCare Graduate Student Health plans, a primary care physician (PCP) is a general or family practitioner, an internal medicine doctor, a pediatrician or an obstetrician/gynecologist. Under Humana and FirstCare, the same doctors, except obstetricians/gynecologists, are considered PCPs. However, at FirstCare, you may be able to pay the PCP copayment for a visit to an obstetrician/gynecologist if you call FirstCare for approval before you go. All other doctors under these plans are considered specialists.
H.E.A.D.s Up is a monthly column that features articles on a wide array of Health, Exercise And Diet issues. Information for these articles is provided by health and wellness professionals from throughout the A&M System. If you have questions or story ideas for this column, email Ruth McMullan.