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Selecting a New Physician
By Kevin Brown

The new 10-year agreement between UPMC and Highmark will save thousands of area residents from having to find new physicians who are “in-network” according to their insurance plans. Prior to the July 1 agreement being signed, however, the threat of having to select new physicians was quite real.

For those who might have been affected, it is a good idea to verify whether your physician will be considered “in-network” under the new agreement. You may find that you still have to change physicians.

Just how does one go about selecting a new physician? Where do you look? What questions should you ask? Where do you start?

The Western Pennsylvania Guide to Good Health has published a Physician Directory in this issue to help you get started. The directory lists area physicians by specialty and includes contact information.

We spoke with Robert C. Cicco, M.D., chair of the Board of Directors of the Allegheny County Medical Society, for advice on how to verify whether your current physician is “in-network” and how to select a new physician. Now retired, Dr. Cicco was the associate director of the Neonatal Intensive Care Unit (NICU) at West Penn Hospital. He also practiced general pediatrics for many years. In 2012, Dr. Cicco was named “Pediatrician of the Year” by the Pennsylvania Chapter of the American Academy of Pediatrics (AAP).

Dr. Cicco feels strongly about people being put in the position of having to change physicians. “The whole concept of insurance driving you to your physician is wrong,” he says. ”People should be saying, ‘This is not right’ and ‘This is not in my best interest to maintain my health.’”

“The advice that I would give for someone who is put in this situation of changing physicians, which they really shouldn’t be put in, is that you need to think about what is it about the relationship you have with your current physician that you really value? You need to try and find somebody where you are going to get that same feeling. It’s hard to be specific about this because it’s a feeling. It really is,” he says.

Dr. Cicco explains that “Health care is based on a physician and a patient having a trusting relationship with one another. It’s not something that happens on the first visit. It’s something that you get a sense of during that first visit, but in terms of really developing that trust it does take time.”

In order to verify whether your physician is “in-network”, Dr. Cicco recommends that you first call your physician and ask, ‘This is my current insurance. How will I be billed and how much is it going to cost me?’

“They may not know the answer to this since a lot of that information is no longer in the physician’s hands. But I would still make that call,” he explains. “The next call should be to your current insurer and, if possible, try to get in writing what’s covered and what’s not covered in terms of who you could see.”

Dr. Cicco recommends talking with your current physician. “If you do have a very good relationship with your physician, I would say, ‘Look, I don’t want to lose you, but I have to because of the insurance. Give me some recommendations of physicians you think I would be able to have the same relationship with that I have with you and who happen to be in the other network.’”

He also recommends talking with family members and friends. “Formalize in your mind what it is that you want from that relationship with your physician and ask those right questions. ‘Does my physician really pay attention to the things that are bothering me? Is the office staff welcoming to me?’”

One consideration is whether people should select “independent” physicians - those who are not employed by one of the major health systems. These physicians may be in private practice or may be employed by hospitals that accept all or most insurances.

“An independent physician has a little more freedom of being able to see you,” says Dr. Cicco. “Let’s say you have to be admitted to a hospital. Your independent physician might have the freedom of saying, ‘I can see you if you go to hospital X, Y, or Z.’ On the other hand, I think that advantage pales in terms of making sure you’re going to a physician who is a good partner for you,” he says.

Hospital websites can be helpful in researching new physicians. Most have physician directories where you can search for physicians by name or specialty. Some hospitals or health systems may even have a physician referral telephone line you can call for help in selecting a physician.

A final word of advice: You are responsible for ensuring that services you receive, whether from a physician, a hospital, or other service provider such as a laboratory, are covered by your insurance plan. You can do this by calling the physician’s office, the hospital, service provider and your insurance company.

The Western Pennsylvania Guide to Good Health Physician Directory is also posted online at www.guidetogoodhealth.com.

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