Why would someone be looking for a doctor?
There are many reasons why a person may need a new doctor. They may have:
- Changed insurance plans.
- Had health changes and started needing a different doctor.
- Decided they don’t like their current doctor.
They may also need or want a specialist (for example, a doctor who focuses on problems of the digestive system).
It is also possible that their former doctor may have:
- Moved or quit working.
- Recommended that they see a different doctor or specialist.
- Stopped taking the person’s insurance.
If someone you support needs a new doctor, they might want your help. Ask if you can help them locate a doctor.
A quick note on health insurance: It is important to know what kind of health insurance the person you support has before you start looking for a doctor. Most people with developmental disabilities have Medi-Cal. Medi-Cal is a form of health insurance paid for by the government. Many doctors do not accept Medi-Cal payments. Find out if the person you support uses Medi-Cal before you start looking for a doctor. If they do, make sure you find a doctor who takes Medi-Cal payments.
How do you find a doctor?
The best way to find a doctor for a person with developmental disabilities is to ask the person’s Regional Center service coordinator for recommendations.
You can also try these other ways to find a doctor:
- If the person you support needs a specialist, ask their regular doctor for a referral.
- Ask the staff at your local hospital or clinic.
- Ask agencies that have special programs for people with disabilities.
If the person you support uses Medi-Cal:
- Call the local Medi-Cal office and ask for a list of doctors who accept Medi-Cal.
- Call the county Pubic Health office. Ask them which doctors see people with disabilities and accept Medi-Cal.
What should you look for in a doctor?
After finding a doctor, you should check and see if they meet your needs or the needs of the person you support. Here are some questions you might ask:
- Is the doctor experienced in caring for people with disabilities?
- Does the doctor take the individual’s health plan (Medi-Cal or their private insurance)?
- Does the doctor's staff have experience serving people with special needs?
- Is it easy to get to the office? Is it near public transportation?
- Is the office accessible for individuals with disabilities – for example, does it have ramps and elevators for people who use wheelchairs?
- Does the doctor have special equipment to accommodate people with disabilities (for example, does the doctor have equipment to transfer a person from their wheelchair to the examination table)?
- When is the doctor's office open? Is there a way to reach the doctor or a substitute when the office is closed?
- Does the doctor have a help line or advice nurse that you or the person you support can call to ask questions?
- How soon can the doctor see the person you support?
How do you find out more about a doctor?
Here are some other ways to find out if the doctor can meet your needs or the needs of the person you support:
- Ask other people who see that doctor.
- Talk to the doctor or their staff over the telephone.
- Ask the individual’s insurance person.
- Look the doctor up on the Internet.
Make an appointment for the person you support to meet the doctor. After the appointment, ask the person how they felt about the doctor.
- Did they feel comfortable with the doctor?
- Did they like the doctor’s office and staff?
How can you prepare to meet the doctor?
After you find a doctor, you or the person you support may want help making an appointment with the doctor, or getting to the doctor's office.
If you are worried or confused about going to see the doctor, you can use the following presentations to help explain how to get ready, and what will happen when you go:
This tool can help them and you remember questions to ask the doctor:
How does health insurance work?
After you or the person you support visits the doctor, the doctor will send a bill to the individual, the insurance company, or Medi-Cal. Health insurance usually pays for doctor’s visits, medications, and other medical bills. Different insurance plans pay for different things; Medi-Cal works like a private insurance plan, in that it only pays for certain things. For more information on Medi-Cal, look at “Medi-Cal, What It Means to You,” a brochure from the Department of Health Care Services:
If the person you support has private insurance, check with their insurance to see what is covered.
How does Medi-Cal work?
Medi-Cal is a health care program for people with low income and people who have SSI (Supplemental Security Income).
Many counties have two kinds of Medi-Cal: regular Medi-Cal, and Medi-Cal Health Plans. Both kinds of Medi-Cal give a person the same basic benefits, but there are differences in how a person chooses a doctor and gets care:
- With regular Medi-Cal, the person must find their own doctors, pharmacies and other providers.
- In Medi-Cal Health Plans, the Plan helps the person find doctors, pharmacies and other providers.
You can find out more about the two kinds of Medi-Cal in this document: “What Are My Medi-Cal Choices?” http://www.dhcs.ca.gov/provgovpart/Documents/SPD%20Guide%20_Eng.pdf.
Medi-Cal pays for medical services in both programs. The person you support can try one type and see if they like it. Call Health Care Options at 1-800-430-4263 or the person’s Regional Center service coordinator to see what the person’s choices are.
What Are My Medi-Cal Choices? Questions and Answers
Guidebook to explain what the two kinds of Medi-Cal are (regular Medi-Cal and Medi-Cal Health Plans) and how to choose which kind of Medi-Cal is right for you (Health Research for Action, 510-643-9543)
Health Care Options
Health Insurance Counseling and Advocacy Program (HICAP)