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Navigating Health Care in New York: Researching Insurance, Medicare, Medicaid, and Providers

his first piece of bureaucracy - _MG_5539seandreilinger on FlickrMany New Yorkers no longer have much choice about who their health care provider is. Many times New Yorkers — if they are fortunate enough to have an employer sponsored or other health care plan — may be asked to choose from among those health care providers who belong to a particular heath care maintenance program or other health insurance program.

Other New Yorkers may be enrolled in the Medicare Program if they are over a certain age — which in many cases means that your health care may also be provided by a private insurer who has a contract with New York State (or you may possibly have a Medigap plan for the many areas of health care that Medicare does not pay for; evaluations of various Medigap plans are provided by Consumer Reports that is accessible on one of the many databases available from the New York Public Library that are available from home).

If you have limited means, you may determine whether you are eligible for Medicaid in New York City. In New York state Medicaid may be administered by private health insurance plans for profit. And a substantial number of New Yorkers have no health insurance plan at all but still need to see a doctor, a dentist, a physical therapist or a psychotherapist or a number of other providers of what is broadly defined as "health care."

Whether one's health care provider must be chosen from a health maintenance organization or insurer, may provide health care as part of Medicare or Medicaid, or is recommended by family or friends, it is always wise to find out more about the health care provider. If your doctor practices in New York State, s/he is licensed by the New York State Department of Health and a good deal of basic and supplemental information is available about him or her in their New York State Physician Profile. In order to search the Physician Profile, it is necessary to have the proper spelling of the physician's name which should be available from either your health insurance provider or from the office of the doctor. This site provides such basic information as whether this physician is licensed by the State of New York, whether the doctor went to an accredited medical school in the United States, where s/he did a residency or internship (a period of from one to several years of training after medical school but before receipt of a medical license) and whether s/he is "Board Certified" in the field. That is, after finishing formal medical training, s/he received post graduate training and supervision that indicates additional training in a specific medical field such as orthopedics or psychiatry. It should also indicate where his or her medical office is, what hospitals licensed in the State of New York s/he can practice in, whether s/he has published research papers in his medical field or has been teaching medicine or providing community service.

One can also determine if a doctor takes one's form of private health insurance or if the doctor provides care to those enrolled in Medicare. Note that certain doctors accept Medicare payments as payment in full while others only accept it as partial payment and you are responsible for the balance. You should also confirm in advance whether a doctor takes any form of private or public medical insurance, and to what extent, by contacting the doctor's office. Only certain doctors in New York accept Medicaid patients. However, if a doctor accepts any Medicaid patient in New York he must accept all.

One may determine if a dentist is licensed to practice in New York from the Office of Professions. And one may determine if a doctor or dentist is licensed to practice outside the state of New York from the database Reference USA available at certain NYPL locations. Physical therapists should have a license from the state of New York. Psychotherapists may be psychiatrists who are licensed physicians in New York who may treat patients and prescribe medication. Clinical psychologists are licensed by the state of New York and usually possess a doctorate from an accredited University training program. Licensed clinical social workers (who possess a Master's Degree in Social Work and three years of post-degree supervised experience) and licensed masters of social work (who possess a Master's Degree in Social Work) are also registered with New York state. Note that there are numerous other accrediting agencies, especially for psychotherapists.

See also J. Soucé's post concerning health care issues of interest to Seniors. More NYPL blog posts about health and medicine.


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A library user came in today

A library user came in today wanting resources on how to care for an elderly parent. I emailed your blog to her. Thanks.

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