One of the first filters in selecting an EPO or PPO individual and family plan, either through Covered California or off-exchange, is determining if your current doctor is in-network. For all the enhancements to online doctor directory search tools, they still suck. They are not consumer friendly. Consumers are given either too many conditions to select or the provider search tool offers too little information.
Online Doctor Search Websites Suck
Unless the consumer is selecting an HMO plan that assigns a Primary Care Physician (PCP), people have to hunt online to see if their doctor accepts one of the several EPO or PPO plans in their region. If the doctor isn’t in-network, the health plan is of nominal value to the consumer as they have to pay the full price of the office visit and services. But searching for doctors is like diving into different haystacks, a different one for each carrier, in order to find the elusive needle. While some health plans like Oscar are fairly simple to use, they offer limited ability to save and print a directory of physicians. Then there are other search engines like Anthem Blue Cross that overwhelm the consumer by forcing them to select a plan type from a drop menu three feet long.
Tips for good provider search results
Here are some tips to determining if your doctor accepts a health plan you are considering.
1. Get the correct spelling of the name.
While looking up doctor network status for a client I was given the doctor’s name as Shawn Veieseh. The last name Veieseh was not found. After some sleuthing, I did find a Dr. Afsin Veiseh in-network for a couple of health plans. First, the last name I was given was spelled wrong. Second, the doc probably introduces himself as Shawn, but his official name is Afsin. At least there is an Afsin Veiseh at the same address for Shawn Veieseh. Also, some doctors use their middle name in conversation. Dr. Mark Davidson is really Robert M. Davidson in the provider directories.
2. Have the address of the provider.
Believe it or not, there is more than one William Smith as a doctor. The correct address will identify whether the Dr. William Smith found in the provider directory is your doctor. While some doctors are listed with multiple addresses because they work out of different offices, usually Dr. William Smith won’t have both a San Francisco and Los Angeles address.
3. Know the specialty for the doctor.
Some provider search tools will only show the doctor as in-network if the correct specialty is chosen. For example, searching for a specific cardiologist on the Anthem Blue Cross website under the specialty of General Care may not bring up the doctor. But searching under the specialty of Cardiology might show the doctor as in-network.
4. Check the radius of the search.
Several of the provider search tools use a radius measurement from the entered zip code to display doctors. If you are searching for a specific doctor within a 10 mile radius, and the doctor is really located 15 miles away, he or she will not be shown as in-network. Blue Shield search tool defaults to 100 miles. While that is great for checking on doctors, it may yield a provider list of several thousand physicians. The radius search needs to be adjusted down to create a more manageable list of doctors.
5. Not all internet browsers work with all online search websites.
If you are experiencing vexing problems such as sliders not working or fields that won’t accept typed data, try switching to a different browser. I’ve run into problems with Google Chrome and Internet Explorer. I’ve had fewer bugs with Firefox, but they still crop up from time to time. You may also need to adjust some settings on your internet browser to allow all the results or data to be displayed.
Some provider search tools are too complex
The Anthem Blue Cross provider search tool makes the user select from a variety of conditions to create the most accurate search results. This complexity, especially with the number plan types the consumer has to choose from, makes the process confusing for many people and may yield erroneous results. The Health Net provider search is so convoluted I wonder if the designers were purposely trying to sabotage enrollment in their health plans. On the other hand, Oscar has very few filters on their search tool. This makes the consumer call the doctor office to see if the provider is actually accepting new patients which is a common feature on other tools.
HMO plans should easily display Physician Groups
The search can be just as complicated for HMO medical groups. With more HMO health plans coming onto the market it is important for consumers to know the Medical or Physician Groups they can select from. There are various Physician Groups can go by similar names such as
- Sutter East Bay Medical Foundation
- Sutter Pacific Medical Foundation
- Sutter Gould Medical Foundation
- Sutter Independent Physicians
- Sutter Medical Foundation
The consumer must first determine which Physician Group is in their area and then search for a doctor within the group.
Don’t search for PPO doctors in a HMO plan type
The doctor search tools need to be changed. Instead of forcing the consumer to select a plan type (EPO, HMO, HSP, PPO, etc.) the various plans the doctor accepts should be noted in the search. If a consumer searches for Dr. William Smith, all the health plans the doctor accepts would be listed. This could be displayed as a check mark in a box for all the health plan types and markets the carrier offers: individual and family, Medi-Cal, Medicare, small group, large group, EPO, HMO, PPO, etc. Better yet, this would be a statewide data base not a carrier specific search tool. You would then be presented with a table of health plan types for the various health plans that the doctor is in-network for.
Why can’t doctors just tell consumers the health insurance they accept?
Of course, if the doctors themselves would just list the health plans they accept on their own website that would really help out consumers. Better yet, have the office receptionist be able to correctly communicate to consumers which plans the doctors accept. The common retort of, “We accept all PPO plans”, is tantamount to saying, “I haven’t a clue, but we are probably out-of-network.” But it may be a bridge too far to ask doctors to actually become consumer friendly.