Picking a doctor - looking for an explanation of some terms

[grigor]

Hi all,

I’ve been with an HMO for several years, so a PCP was assigned to me and that was fine.

I’m switching to a new health plan - this one has great in-network but no out-of-network coverage (except for emergency). I’m supposed to pick a PCP to be my primary point of contact to coordinate all care. I’m young and healthy, but I’m also interested in seeing a dermatologist and maybe seeking some mental health services. No rush on those - I figure I can coordinate through my PCP and insurance.

But a few questions:

1. Some of the doctors closest to my home aren’t affiliated with in-network hospitals. Does this matter? What’s the deal with “admitting privileges” anyway?
2. Does it matter if their specialty is “General medicine” vs “Internal medicine” vs “Family medicine?” What about PCPs that list a specialty of pediatrics?
3. Some are “MD” and some are “DO.” Should I have a preference for one over another?
4. One doctor (Dr. Y) works in a small practice with two others (Dr. J and Dr. S). Only Dr. Y is listed on my insurance website. Is that a problem? Does that mean that Drs. J and S don’t take my insurance?

Thanks in advance!

 

[ryanc111]

@grigor

1. It would mostly matter if you had chronic conditions needing attention, and you ALSO needed hospitalization.

Increasingly, hospitals employ "hospitalists" to handle your 'ordinary' care while in hospital - and generalists basically don't come by to see you anyway.

1. Their 'generalist specialty' doesn't matter a whole lot as long as you're comfortable that they a) listen to you b) are competent at general health treatment/clinical attention for you. Some women express a preference for having their OB/GYN act as their generalist; this used to be a 'selling feature' for some plan designs, but I'm not seeing it given as much attention anymore (I may be wrong about that)
2. DO= Doctor of Osteopathy. They're doctors, who give extra attention to the matter of your bones & their alignment. You might not notice a difference; if you have time/opportunity, have a DO explain how their practice differs from a "regular" MD
3. Yeah, this is a thing to pay attention to. Some insurers contract with individual MDs, some make a practice of contracting across all clinicians in a practice group. Your MDs partners may/may not be network physicians for the same plan - but they MIGHT be network MDs for different plans with the SAME insurer. Isn't health insurance fun?

 

[royalty10]

@grigor

One doctor (Dr. Y) works in a small practice with two others (Dr. J and Dr. S). Only Dr. Y is listed on my insurance website. Is that a problem? Does that mean that Drs. J and S don’t take my insurance?

It might. It's very common for doctors in the same clinic to accept different types of insurance. Always verify that the specific doctor/therapist/practitioner is covered by name with your insurer. Don't ask if a facility is covered unless it's a lab or a hospital (and yes, then you can still be in an in-network hospital but billed by an out-of-network practitioner, because US healthcare system sucks).