Healthcare Provider

What Is a Healthcare Provider?

In the U.S., a healthcare provider is defined as "a doctor of medicine or osteopathy who is authorized to practice medicine or surgery (as appropriate) by the State in which the doctor practices; or any other person determined by the Secretary to be capable of providing healthcare services." 

There is a variety of types of care providers, but the term refers to a person or facility that provides healthcare services to you or your family. Insurance companies normally require you to go to care providers that are in-network. Some insurance policies will provide reduced rates of coverage for care providers outside of the network or provide no coverage.

What Do Healthcare Providers Do?

A healthcare provider is in charge of preserving the well-being of patients. Depending on their area of practice, they may handle everything from testing your blood pressure to removing brain tumors. Dentists, chiropractors, psychologists, and midwives are all considered healthcare providers. 

Different Types of Healthcare Providers

The most common type of provider is a primary care provider, which is usually a doctor or practice that specializes in general medicine. Providers may also fall under a number of categories depending on what they do.  There are nursing care providers, drug therapy providers and specialists. There is a huge variety of specialists, and they include cardiologists, anesthesiologists, and nephrologists, just to name a few. 

Is There More Than One Type of Healthcare Provider?

Yes, there is more than one type of healthcare provider.  In relation to health insurance, you'll normally select a primary care provider to see for most of your basic healthcare needs. Primary care providers are often doctors, but they may also be nurse practitioners and internists. 

These individuals, or groups, will normally handle all of the basic healthcare needs you have.  They will also connect you to specialists and other types of care providers. With many health insurance policies, before you can see a specialist, you need to get a referral from your primary care provider. 

A List of the Different Types of Healthcare Providers

In addition to primary care providers, other types of healthcare providers include:

  • Surgeons 
  • Mental health professionals
  • Dentists 
  • Optometrists 

Most medical professionals who are tasked with overseeing your health and well-being are considered healthcare providers.

Finding a Healthcare Provider

Finding a healthcare provider is easier than ever with.  You have different mediums of finding healthcare providers including health review sites, but most often people find healthcare providers by referrals from those they trust, or through a list of approved in-network providers from their health insurance company.

How to Choose a Healthcare Provider

Picking a primary care provider is important because this is the individual you will be going to, at least initially, for most or all of your healthcare concerns. One of the most important aspects of choosing a primary care provider is finding one that's in your network, which means that the insurance policy you have will cover your visits to this provider.

It's also a good idea to find out how easy it is to get appointments with this provider and if their office hours will work with your schedule. If you have children or are older, it may be a good idea to look for a primary care provider that focuses on people in specific age groups.

How to Enroll With a Healthcare Provider

Your health insurance provider should have a list of in-network providers. If your plan is an HMO, a provider might even be chosen for you. Visit your health provider's website or contact them to find a list of in-network providers. Then research the ones who are convenient to you and find one that seems suitable. Contact the provider to schedule your first appointment, and let them know that you're a new patient. They'll provide you with some paperwork to fill out, and they'll enter your information into their system. 

You can normally change your primary care provider, but you'll need to go through your insurance company. Some companies limit when you can change providers and how often, so you may only be able to make changes during a signup period or once a year.