Your insurance plan may restrict your choices to a group of plan-approved physicians or offer financial incentives to use plan-affiliated doctors. Always check the terms of your insurance coverage to find out whether the plan will cover visits to the physician you are considering. If he or she does not participate in your health plan, how much will you pay out-of-pocket for visits to this provider? Does the health plan require a referral from a primary care physician before you can see a specialist? If you have changed jobs and must decide among different health plans offered by your employer, you may want to make your choice of doctor first and then choose the health plan that covers visits to this physician.
You will also need to decide what type of physician you are looking for. Most plans require you to choose a primary health care provider (a doctor who will manage your overall care and refer you to specialists when needed). In addition, if you have a chronic or disabling condition you will likely need a specialist who understands your particular health needs.
Most practicing physicians in the U.S. are board certified. Primary care physicians — doctors you would see for routine ailments such as a cold, the flu, and regular checkups — may be board certified in family medicine or internal medicine; specialists — doctors you would see for special procedures such as a colonoscopy or for a chronic disease — have completed residency training in a specific field following graduation from medical school and have passed a competency exam in that field.
It is also possible to find out whether a doctor is in good standing with state licensing agencies through a Web site run by administrators of several state medical licensure boards. The site Administrators In Medicine can provide information about disciplinary actions taken or criminal charges filed against physicians in many states.