How Do You Find Out If a Medical Specialist Is Covered by Your Insurance?


Quick Answer

One option to determine if a specialist is covered by a person's insurance is to search on the insurer's website for in-network physicians. Another is to call the customer service number on the insurance card and speak to a representative to ask if a certain doctor is covered.

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How Do You Find Out If a Medical Specialist Is Covered by Your Insurance?
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Full Answer

Many major insurance carriers have search pages on their websites where consumers can search for in-network physicians. A consumer can usually search by criteria such as the doctor's name or by doctors within a certain distance of a city or ZIP code.

For example, Blue Cross Blue Shield has a National Doctor and Hospital Finder feature on its website where a person can search by doctor's name, specialty, procedures and location. It also helps if a user has his or her plan type available, such as PPO/EPO, PPO Basic, to get more accurate search results. Similarly, on Aetna's website, an insured can search by similar criteria. The user can specify the appropriate plan type, and a list of available doctors appears. When clicking on a doctor's name, the doctor's page states what specific health plans are covered.

Even if a doctor is not in-network, the doctor may still be partially covered by the health insurance as an out-of-network provider. However, such providers are typically subject to higher deductibles and copays, which vary from plan to plan.

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