How do I know if the doctor in the insurance network is any good?

Choosing a doctor can be tough. Most folks want to pick a doctor who is qualified and considered a good physician. To that end, most folks want to first pick a doctor who is good and secondarily is in the insurance company provider network.  Often though folks want to do the searching for new providers within their network so that raises the question how to know what doctors in the network are quality.

In the business world and medicine in the USA does fall into a business world model, we often see discounts provided by vendors trying to build a client following. There is no real indication of good or bad quality just because some vendor offers a discount. We see discounts from top car makers and even top restaurants at various times. Most vendors often have some excess capacity they want to fill and discounting or offering specials helps fill that void.

Healthcare providers who are new often join every network they can so they are able to fill their appointment books with new patients. Also, many specialist physicians are involved with networks in order to ensure they can see referral patients. As they build referral relationships, they don’t want the new referring physicians to have to give too much thought to what patients they can refer or not refer. Also, physicians often are in networks for the benefit of the patients they serve allowing them to get in-network benefits when receiving care.

Now that we have discusses several reasons physicians may join provider networks, let’s look at how you can pick a good dock from the group of network physicians.  Most of the provider networks now have markers for physicians who meet various criteria that allow them to be held out as better than average physicians. There are a number of ways the insurance companies evaluate who gets their preferential ratings among the various insurance carriers. Typically various educational and board certification requirements are in place. Then for most of them, there are requirements that the provider have treated enough member of the insurance company with good cost effective outcomes.

Cost effective outcomes can be measured more than one way. There is the skeptical way to evaluate it, where keeping costs low is most important while the actual outcomes don’t come into play much. There is a mix where outcome is measured primarily by follow-up treatment needs. Thus care is evaluated around specific major medical conditions or surgical episodes and using various statistics, that give a fair indication of needed care around these incidents before, during and after the episode of care.

Regardless of the way the care is measured, if it is measured the same way for all providers within the carrier, ultimately within a carrier the data is going to remain valid. Using this data as a guide and checking with other physicians you know is ultimately the best way to check on the physicians you want to know about.