“Provider access” is about more than having a doctor’s name on your insurance card. It means you can:
Find a primary care provider and specialists who accept your insurance
Schedule appointments in a reasonable time frame
Reach care by phone, patient portal, or telehealth when in-person visits are not possible
Receive coordinated care when you see more than one provider
Healthy People 2030, a major national public health initiative, highlights access to primary care as a key social determinant of health. Having a usual source of care is linked to better use of preventive services and improved health outcomes.
CDC data show that most adults in the United States have a usual place for care, yet a meaningful share still cannot get needed medical care because of cost or other barriers. Difficulty getting to care on time, long wait lists, or trouble finding a provider who takes your insurance can lead to delayed diagnoses, poorly controlled chronic conditions, and avoidable hospital stays.
Continuity of care, meaning an ongoing relationship with a primary care provider over time, has been linked in systematic reviews to fewer emergency department visits, fewer hospitalizations, and better quality of life, especially for older adults and those with multiple conditions.
If you are struggling to get appointments, to find in-network specialists, or to coordinate multiple referrals, you are not alone, and there are concrete steps that can help.
Common barriers to getting the care you need
Many patients, caregivers, and older adults face similar obstacles when they try to see a provider. Understanding the barriers can make it easier to plan around them and ask for support.
Insurance and network rules
Insurance coverage is one of the most common reasons people delay or skip care. Healthy People 2030 notes that lack of insurance and network limitations are linked to lower use of preventive and primary care and worse health outcomes.
You might face:
Confusion about which providers are “in network” for your specific plan
Offices that say they are not sure whether they accept your plan
Requirements for referrals or prior authorization before you can see a specialist
Different rules for Medicare, Medicaid, and employer or marketplace plans
Research on access to specialty care has found that insurance details and plan rules often compound other barriers, making it harder to complete referrals and get to the right specialist.
Appointment availability and long wait times
Even when you have insurance, you may encounter:
No available appointments for weeks or months
Providers who are not accepting new patients
Canceled visits that are difficult to reschedule
CDC analyses of national survey data show that many adults delay or skip care because an appointment was not available when needed or it took too long to get to a provider. A national survey on specialty care found that about one third of people who needed a specialist reported at least one barrier, with difficulty getting an appointment and long wait times among the top reasons.
Transportation and distance
Getting to the doctor can be challenging if you:
Rely on public transportation or rides from others
Have mobility limitations, use a walker or wheelchair, or tire easily
Live in a rural area or far from large medical centers
The Healthy People 2030 literature summary on access to primary care highlights transportation, travel distance, and shortages of local providers as important barriers, especially in rural communities. People with disabilities are also more likely to report difficulty accessing health care in general.
Complex health needs and fragmented care
If you manage several conditions, see multiple specialists, or have been in and out of the hospital, you may experience:
Conflicting instructions from different providers
Tests, imaging, or labs that are repeated or delayed
Uncertainty about who is “in charge” of your overall care
The Agency for Healthcare Research and Quality (AHRQ) describes care coordination as making sure the “right care” happens at the “right time,” with clear information sharing across providers and settings. When coordination is weak, it can become much harder for you to access the provider who knows you best and understands the whole picture.
Technology and language barriers
Telehealth, online portals, and digital scheduling can expand access, but only if you can use them and understand the information.
Studies and federal data show that:
Telehealth can reduce transportation barriers and help people in rural or underserved areas access primary and specialty care.
Older adults and people with limited internet access may have difficulty using video visits or online portals without support.
People who speak languages other than English can face extra challenges when systems and portals are available only in English.
If you feel overwhelmed by technology or medical terms, you are not alone. It is completely reasonable to ask for help.
Primary care, specialty care, and when you might need a new provider
What primary care does for you
A primary care provider (PCP) is often your main partner in managing day-to-day health. MedlinePlus describes primary care providers as clinicians who handle common medical problems, preventive care, and long-term management of many chronic conditions.
Your primary care provider can:
Perform annual checkups and screenings
Manage conditions like high blood pressure, diabetes, COPD, and depression
Coordinate referrals to specialists
Help you weigh risks and benefits of different treatment options
Provide ongoing care that builds a relationship over time
Continuity with a primary care provider, particularly in family medicine or internal medicine, is associated with fewer hospitalizations and better quality of life for older adults.
When you may need a specialist
Your PCP may refer you to a specialist when you:
Have symptoms that need more focused evaluation, for example persistent chest pain, complex endocrine issues, or unusual skin changes
Need procedures or surgeries that primary care does not perform
Have chronic conditions that are difficult to control, such as severe diabetes, advanced heart disease, or complicated neuropathy
Recent work in health services research has shown that access to specialty care is associated with lower preventable hospitalization rates and better outcomes, especially for rural Medicare beneficiaries and patients with complex chronic disease.
Signs it might be time to look for a new provider
You may consider changing primary care or specialists if you:
Consistently struggle to get appointments or follow-up
Do not feel heard or respected in visits
Have difficulty communicating about your priorities and concerns
Have moved, changed insurance, or your provider no longer accepts your plan
NIH resources on talking with your doctor emphasize the importance of feeling comfortable asking questions, understanding instructions, and being able to speak openly about symptoms and goals.
If you feel stuck, a care advocate can help you explore new options that better fit your needs.
How referrals and insurance networks work
What a referral does
A referral is a formal communication from your primary care provider that:
Explains why you need to see a specialist
Sends key parts of your medical record, such as notes, lab results, or imaging reports
May be required by your insurance plan before it will cover the visit
Guides on transitions of care describe outpatient referrals and follow-up visits as crucial steps to maintain continuity when you move between care settings or providers.
Without a complete referral, a specialist’s office may:
Not schedule your visit
Schedule you but later request more information
Submit claims that are delayed or denied by your insurance plan
Insurance networks, benefits, and prior authorizations
Each insurance plan has its own network of providers, facilities, and rules. To avoid unexpected bills, it helps to ask:
Is this provider in network for my specific plan?
Are they currently accepting new patients?
Is a referral required?
Is prior authorization needed for the visit or for specific tests or procedures?
National survey data show that many adults delay or skip care because they cannot find a provider who accepts their insurance or because appointments are not available when needed.
A care advocate can take on many of these phone calls for you, confirming details with provider offices and your insurance company so that you are not left on hold trying to track down each answer yourself.
Questions to ask when choosing a provider
MedlinePlus and NIH suggest being prepared with questions when choosing or meeting a provider. You might ask:
Do you accept my insurance, and are you in network for my specific plan type?
How soon can I be seen for a new patient visit?
What is your approach to communication between visits, such as portal messages or phone calls?
How do you coordinate with my other providers?
Do you offer telehealth visits, and if so, when are those available?
Writing questions down and bringing them with you can make your visit more productive and help ensure your main concerns are addressed.
Ways to expand your options for care
Telehealth and virtual visits
Telehealth can include video visits, phone visits, remote monitoring, and secure messages. NIH and CDC resources note that:
Telehealth can help people in rural or underserved areas connect with care without traveling long distances.
Telehealth has been used to improve management of chronic conditions such as heart disease and diabetes, especially when paired with in-person care.
If you are considering telehealth, you can ask the office about:
Whether your visit can be by video or phone
How to test your device before the visit
What to do if you lose connection during the appointment
Whether a caregiver can join the visit from another location
For many people, telehealth can be used for medication follow-up, reviewing test results, or discussing chronic disease management, while in-person visits are still important for certain exams or procedures.
Community health centers and clinics
If you have limited insurance, are between plans, or have trouble finding providers who accept your coverage, community health centers can be an important option.
The Health Resources and Services Administration (HRSA) reports that federally supported health centers serve more than 30 million people across the United States, including rural and underserved communities. These centers often:
Provide primary care regardless of your ability to pay
Offer sliding fee scales based on income
Have staff experienced in helping patients enroll in coverage and connect to specialists
A care advocate can help you identify community health centers near you and call on your behalf to ask about new patient availability and services.
Preparing for each visit so your concerns are heard
MedlinePlus and NIH advise that preparing for your visit can help you make the most of the time with your provider. Consider:
Bringing an up-to-date list of medications, including over-the-counter medicines and supplements
Writing down your top 2 or 3 questions or concerns
Bringing recent test results if they were done outside your main health system
Asking a trusted friend or family member to join you if you want support
Preparation does not need to be perfect. A few notes and a medication list can already make the visit less stressful and more focused on what matters most to you.
How Understood Care advocates support provider access
Understood Care advocates are trained to help you overcome many of the practical barriers to provider access. The support they offer lines up closely with what is described in the video on this page.
When your doctor has already placed a referral
If your current doctor has placed a referral to a specialist, an advocate can:
Confirm that the referral was sent to the correct office or specialist
Check that the specialist’s office actually received the referral and can view your records
Contact your doctor’s clinical team if additional information, such as lab results or imaging, is needed
Ask whether the specialist requires any forms, imaging, or labs to be completed before your visit
Referrals often bounce between fax machines, portals, and busy front desks. Instead of you making repeated calls, your advocate can follow the referral from your primary care provider to the specialist, step by step, until it is accepted and an appointment can be scheduled.
If you still need a new provider
You might not yet have a primary care provider or specialist, or you may be ready to find a new one. In that case, an advocate can:
Help you clarify what type of provider you need, such as primary care, dermatologist, pain management specialist, endocrinologist, or another specialty
Check your insurance network to find providers who accept your specific plan
Call offices to confirm they are accepting new patients, and that they truly take your exact plan, not just the broader insurance brand
Ask about practical issues such as accessibility, interpreter services, telehealth availability, and office hours
This saves you from having to call multiple offices, repeat your insurance information many times, and sit on hold while staff check policies.
Helping you choose between in-person and telehealth
Sometimes offices require an in-person “new patient” visit. Other times, they can start with a telehealth appointment. Your advocate can:
Ask the office whether your first visit can be virtual or must be in person
Help you schedule telehealth if it is an option
Coordinate with your doctor if an in-person evaluation is required before a referral will be accepted
Help you find transportation options, including ride services or community programs, if an in-person visit is necessary
Advocates can also help you prepare for a telehealth visit by reviewing basic technology steps and helping you plan your questions.
Reducing time on hold and staying with you through the process
Provider access is rarely a single phone call. It is a process. Understood Care advocates stay with you over time by:
Following up if a referral has not been received or needs to be resent
Checking if test results or reports have been shared between providers
Confirming that your insurance approvals are in place before a procedure, when possible
Helping you reschedule if an appointment is canceled or if your health needs change
The goal is for you not to feel alone in a maze of phone trees and portals. Your advocate becomes a consistent point of contact who understands your story and helps keep everything moving.
When to seek urgent or emergency care
Even with the best access and coordination, some symptoms need immediate attention. You should seek urgent or emergency care right away, or call 911, rather than waiting for a routine appointment, if you experience:
Chest pain, pressure, or discomfort, especially if it spreads to the arm, jaw, or back
Sudden shortness of breath or trouble breathing
Signs of stroke, such as sudden weakness on one side of the body, facial drooping, trouble speaking, or confusion
Sudden severe headache unlike anything you have had before
High fever with confusion, difficulty waking, or trouble staying hydrated
Suicidal thoughts or concern that you may hurt yourself or someone else
Any symptom that feels severe, rapidly worsening, or frightening
If you are unsure, you can call your provider’s office or nurse line if available, but if there is any concern about a life-threatening emergency, call 911 immediately.
Frequently asked questions (FAQs) about provider access
Is provider access really that important if I already use urgent care when I am sick?
Urgent care can be very helpful for sudden issues, such as minor injuries or infections. However, research shows that having a usual source of primary care is linked to better preventive care, improved chronic disease management, and fewer avoidable hospitalizations.
A primary care provider can:
Track your health over time
Notice changes that might otherwise be missed
Coordinate specialists and tests
Help you choose treatments that fit your goals and circumstances
Urgent care is an important backup, but it is not designed to replace continuous, relationship-based primary care.
How do I find an in-network specialist who is accepting new patients?
You can:
Check your insurance plan’s website or member portal for in-network providers
Call the number on the back of your insurance card and ask for a list of specialists
Ask your primary care provider which specialists they work with most often
Use trusted health system or community clinic websites to search for specialists
Understood Care advocates can take these steps for you, then call offices to confirm that they are accepting new patients and accept your exact insurance plan, not just the brand name. This reduces the chance of surprise bills or repeated “we do not take that plan” conversations.
What can I do if every provider I call has a long wait time?
If you keep hearing about long waits:
Ask to be placed on a cancellation or wait list
Ask whether there are other locations or providers in the same group with earlier availability
Check if a telehealth visit is possible sooner, even if you still need an in-person visit later
Talk with your primary care provider about whether your symptoms or diagnosis justify an urgent referral
Advocates can call multiple offices for you, track wait times, and help identify options such as community health centers or academic medical centers if appropriate. In national surveys, appointment availability and distance are among the most common nonfinancial barriers to care, so needing help here is very common.
How can telehealth improve my access to care?
Telehealth can help you:
Avoid travel, especially if you have mobility challenges or live far from clinics
Get follow-up care sooner when schedules are tight
Involve a caregiver who joins from another location
Stay connected between in-person visits for chronic disease management
NIH and CDC resources show that telehealth can reduce barriers related to transportation and distance, particularly for chronic disease care, although digital access and comfort with technology can still be challenges.
An advocate can help you decide which concerns are appropriate for telehealth, set up appointments, and troubleshoot simple technology questions.
How can an advocate help me with referrals and provider access?
Advocates cannot replace your medical providers, but they can:
Make sure referrals are sent, received, and complete
Coordinate with clinical teams when more information is needed
Confirm that providers are in network and accepting new patients
Help you choose between in-person and telehealth visits
Coordinate transportation support through services or community programs
Follow the process from the initial referral all the way to your specialist visit and beyond
This kind of coordination aligns with what research identifies as effective care coordination, which improves patient experiences and can reduce unnecessary hospitalizations.
What information should I have ready before I call a new provider?
It helps to have:
Your insurance card and plan type
A list of your current medications and allergies
The name of your primary care provider and any referring doctor
A simple description of why you are seeking care, such as “new neurologist for neuropathy” or “endocrinologist for difficult-to-control diabetes”
Any deadlines, such as follow-up needed within a certain time after a hospital discharge
MedlinePlus and NIH suggest writing down your questions and important details so that calls and visits are less stressful and more effective. An advocate can also gather and organize this information with you.
Important: This article is for general educational purposes only. It does not provide medical advice, diagnosis, or treatment and should not replace guidance from your health care providers. Always talk with your doctor, nurse, or other qualified professional about personal medical questions or concerns. If you think you are experiencing a medical emergency, call 911 right away.
Ng AE, Adjaye-Gbewonyo D, Dahlhamer JM. Sociodemographic differences in nonfinancial access barriers to health care among adults: United States, 2022. National Health Statistics Reports, Number 207. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/data/nhsr/nhsr207.pdf
