Policymakers and advocates have called for policies and programs to expand access to health insurance, but for many Americans, being insured doesn’t automatically guarantee finding a provider who will see them.
In 2019, more than one in seven (15.5 percent) adults with health insurance coverage all year reported difficulty finding a health care provider who would see them in the previous 12 months according to the Health Reform Monitoring Survey, a nationally representative survey of adults 18 to 64 years old.
Among adults who had problems finding a new provider, half reported being told by one or more providers that they weren’t taking new patients, and almost two-thirds were told by one or more providers that they didn’t take the consumer’s health insurance.
Low- and moderate-income adults, adults with chronic health conditions, and adults with Medicaid or other public coverage were more likely to report problems finding a new provider. More than one in five full-year-insured low-income adults, adults with a chronic condition, and adults with public coverage reported difficulty finding a provider during the previous year.
What consumers say about finding a new provider
What problems did consumers encounter when searching for a new provider? In follow-up interviews with 30 respondents, many reported that their health plan’s information on participating providers was outdated. Similarly, provider websites often offered limited information on what health insurance they accepted and whether they were accepting new patients, limiting a consumer’s ability to quickly screen potential providers.
Consumers reported making as many as 20 calls to different providers to find care and often faced long waits—from multiple months to more than a year—to see the new provider.
Consistent with previous research, consumers with Medicaid and other public coverage and employer-sponsored insurance also said that locating a new behavioral health provider was particularly difficult. In addition to taking new patients and accepting their health insurance, consumers are seeking a provider who is also a “good fit” for their mental health needs, as one interviewee put it. For that consumer, finding a behavioral health provider who made her feel comfortable and who specialized in a particular type of mental health care offering certain methodologies (behavioral therapies to treat anxiety and stress) required additional screening.
Finding specialists to treat chronic health conditions was similarly problematic. One consumer with Medicaid coverage waited a year to see neurologist. Another person with employer-sponsored insurance waited two months to see a metabolic specialist. Another Medicaid-covered consumer tried to get an appointment with an optometrist but could not find a provider in her town who accepted Medicaid. Eventually, she found an optometrist who treated her as a charity care patient.
Though most consumers eventually found a provider who would see them, some reported giving up searching and instead relying on online resources, suicide hotlines, or hospital emergency departments. Even among those who were able to locate a provider, there were often consequences from delayed care, including worsening health conditions, increased pain, going without needed medications, and not being able to work.
How can health plans and providers make it easier for consumers to find new providers?
Research has shown that consumers’ first priority is whether a provider accepts their insurance (PDF), followed by clinical expertise.
The consumers we spoke with recommended that health plans do a better job of maintaining basic information on their provider networks and that providers do a better job of updating their websites to reflect what health insurance they accept and whether they are accepting new patients.
Consumers also want health plans to expand their provider networks to improve access to care, because many providers who participated in their health plan were either not taking new patients, or seeing them required long waits for care.
The significant shift to telehealth with the COVID-19 pandemic could expand the reach of health plan provider networks and ease some access problems by removing geographic and transportation barriers that often exist between patients and providers. But increased use of telehealth does not necessarily guarantee improved access for everyone. Some consumers do not have ready access to the internet or devices or are not familiar with the technology needed to have a telehealth call with a provider.
As the nation debates what’s next for health care, it is essential to not only talk about the importance of having health insurance coverage but also to address the persistent gaps in access to health care for those with coverage.