Finding a Good Doctor When You Have Diabetes

Restrictions placed by insurers on healthcare services often make it difficult for people to choose the doctors they prefer.

Today, finding a good doctor requires aggressively researching the healthcare plans that an employer or the healthcare market offers.

Those who have diabetes will want the illness managed by a team of specialists. Insurers frequently want primary care physicians to provide most patient care.

The best-case scenario, and the most cost-effective, is having a primary care physician who collaborates well with a team of specialists (e.g., endocrinologist, nurse educator, dietitian).

Dr. Ideal

It is important to know that today’s primary care doctor is meant to serve the needs of both patient and insurer by seeing that medical needs are met in cost-effective ways. This means primary physicians are gatekeepers, regulating the stream of patient referrals to more costly, specialized types of care.

Ideally, your primary care physician will have an interest in and be knowledgeable about diabetes. He or she will also realize that at some point you will require the expertise of specialists, and will not allow disincentives – placed on doctors by insurers – to prevent a referral.

Some insurance programs allow diabetes specialists to register as primary care physicians – a doubly-ideal primary care scenario for anyone with diabetes. However, in other insurance plans, specialists are considered “tertiary care physicians,” requiring a sometimes lengthy referral process to access.

Questions to Ask

When possible, pick the health plan that gives you the greatest freedom to see different doctors in order to cover all of your healthcare necessities.

Just because specialists you like are listed on a healthcare plan does not mean it will be easy to see them. Ask the specialist how hard it is to schedule with them under the plan you are considering.

You will also want answers to the following questions before selecting an insurance plan and physician:

  1. Are the doctors I am seeing now covered under this insurance plan?
  2. What deductibles and co-pays are required and how does this compare to seeing “out-of-network” physicians?
  3. Does the plan include weight loss or fitness programs, diabetes education, dietitians or mental health counseling? If so, who or where can I get these services from?
  4. Under this plan, if a person with diabetes develops a diabetes complication or becomes pregnant, are there preexisting condition or other rules that limit what the insurance will pay for?
  5. Does this plan cover glucose monitoring supplies and equipment, insulin and other diabetes medications, injection, or insulin pump supplies?

If you do not have all the answers prior to joining a plan, question your primary care physician when you first meet. Their responses will help you determine whether you are comfortable with your choice of doctor.

If you do not like what you hear, or you simply feel uncomfortable with the doctor, one recommendation is to look for another by asking friends and co-workers about their primary doctors. Other good sources of physician information are diabetes support groups or meetings of local diabetes associations.

Source: Joslin Center
Photo credit: Vic / flickr creative commons

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