Healthcare can be complicated. And when you are injured and need help fast, it can be confusing to know who to call, especially if you don't have a regular doctor that you see.
With healthcare costs rising every year, it's more important than ever to make sure that the doctor and services you receive will be covered by your insurance. If not, your out-of-pocket costs can add up quickly.
Today, we're giving you a step by step guide on how to find out which doctors are in your network and important questions to ask before you set the appointment.
BlueCross BlueShield
For BlueCross BlueShield customers, follow the instructions below to find a doctor near you in your network.
Step 1: Get out your insurance card, and look and see who the provider is. Go to their website to start looking for a doctor in your network.
Step 2: Choose your network, the specialty you need, and your location. For this step, we chose BlueCard PPO/EPO for the network, Internal Medicine for the specialty, and within 10 miles of Nashville as the location.
TIP: If you are looking for a family doctor to asses you, you can choose to search for "Family Practice" or "Internal Medicine." Both will see adult patients. The difference is that a family practice doctor can also see children where an internal medicine doctor will only see adults.
Step 3: Narrow your choices. When we searched, 200 doctors came up! That's a lot of choices. You may need to enter your member ID at some point to narrow down your options. You'll find this on your card as pictured below.
You can also narrow your choices using ratings, gender, specialty, etc. We picked doctors with a 5 star rating and this gave us 50 to choose from. BlueCross Blueshield provides a handy map to the right, which lets you find a doctor close to your home.
Step 4: Once you decide on a doctor, call the office to set an appointment. BlueCross BlueShield gives you the address, phone number and some other information about the doctor.
TennCare
For TennCare customers, the process of setting up an appointment also starts with your insurance card. TennCare is handled through various Managed Care Organizations. You can see which one you are in by looking at your insurance card. Click here to see Managed Care Organizations in Middle Tennessee.
One of the organizations is United Healthcare Community Plan. We'll use this one as an example.
Step 1: Go to United Healthcare Community Plan's website from the TennCare site. Click on "Select your State" and choose Tennessee.
Step 2: Click on "Claims and Member Information."
Setp 3: Click on "Search for a provider." This will take you to a search feature where you can find a doctor!
Step 4: This is where you can put in a few details. Under Plan Name, you'll want to look at your card and see which plan you are on.
Step 5: Here, you can simply search for a primary care physician or you can search by specialty. Enter your city, state, county, zip code, and a mile radius that you'd like to stay within. Be sure to look for doctors that are accepting new patients, and you can even narrow the search by group or medical practice if you know the name.
Step 6: Our search returned over 700 doctors! As you can see by the screenshot, they are listed in alphabetical order. The list gives enough information to call the office and make your appointment. They also provide a map to make sure the office is a comfortable distance from home.
What if you have trouble finding the right doctor in your network?
You can always call a doctor's office and ask if they will give a discount for a cash payment upfront. This is becoming more accepted in lieu of the long drawn out process of collecting payment from an insurance company, but it depends on the doctor's office.
How can you prepare for your doctor's visit?
You will only get a short time with your doctor, so it's best to be prepared! Knowing what questions you want to ask will help you get the most out of your visit.
Do you want to talk about an injury or health problem?
Do you need to update your medications or ask about a new medication?
Do you need to talk through treatment options?
Don't let setting an appointment get complicated! Most insurance companies will have similar search features like BlueCross BlueShield and United Healthcare Community Plan. And they will all have phone numbers that will connect you to a representative who can answer questions about your plan and help you find a doctor.