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How Do I Use My Health Insurance When I Visit A Doctor?

If, like many Americans, you have been without health insurance, and just recently enrolled in a health plan as required by the Affordable Care Act (ACA), you will need to select a doctor to coordinate your health care. Doctor visits must be covered by your insurance as one of the 10 essential benefits under the ACA. Some plans require you select one primary care provider. Others allow you to visit any doctor within a plan’s network.

To maximize the benefits of your new insurance policy, you will likely need to choose a doctor from within your health plan’s network. These doctors have contracted with your health insurance company to provide services. While many plans will pay some benefits for services provided by an out-of-network doctor, you will generally have less out-of-pocket costs visiting an in-network provider.

To locate a doctor in your health plan’s network, consult your plan’s provider directory. You will find this on the company’s website. If you have a specific doctor in mind, you may call your insurer to determine if he or she is in the network. You will find the customer service number on your insurance card. You may also directly call the doctor’s office and ask if they accept your insurance. Have your insurance card ready when you call so you will be able to identify the exact name of your plan.

The first visit to your new doctor will be to establish yourself as a patient. Bring your insurance card to this appointment, it contains the information your doctor needs for billing. Your doctor may schedule you for preventative screenings, which may require you visit a laboratory to have blood drawn, or see a specialist for specific tests such as a colonoscopy, bone density test or a mammogram. The doctor’s clerical staff will generally verify that your insurance plan coverage includes the providers of these procedures.

Depending on your plan, you may be required to make a co-payment or pay co-insurance. Under a provision of the ACA, some preventative services must be paid for in full by the insurance company. You will have no out-of-pocket expense for these.

If you have a specific health issue that requires a specialist--for example, you wish to see a physical therapist or a mental health professional--some plans require that your primary care physician provide a referral. With other plans, you may schedule these appointments yourself. Check your plan’s documents or call the insurance company’s customer service number to determine if a referral is necessary.

Gillian Burdett is a freelance writer covering all things home and living. Her work can be found on

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