Provider Access

What provider access means and why it matters

“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.

References

• Office of Disease Prevention and Health Promotion. Access to Primary Care – Healthy People 2030 literature summary. U.S. Department of Health and Human Services. https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/access-primary-care
• Centers for Disease Control and Prevention. Access to Health Care, FastStats. National Center for Health Statistics. https://www.cdc.gov/nchs/fastats/access-to-health-care.htm
• 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
• Centers for Disease Control and Prevention. Prevalence of disabilities and health care access by disability status and type among adults. https://www.cdc.gov/disability-and-health/articles-documents/disabilities-health-care-access.html
• Telehealth interventions to improve chronic disease. Cardiovascular Disease Data, Tools, and Evaluation Resources. Centers for Disease Control and Prevention. https://www.cdc.gov/cardiovascular-resources/php/data-research/telehealth.html
• National Institute on Aging. Telehealth: What is it, how to prepare, is it covered? https://www.nia.nih.gov/health/medical-care-and-appointments/telehealth-what-it-how-prepare-it-covered
• MedlinePlus. Choosing a primary care provider. U.S. National Library of Medicine. https://medlineplus.gov/ency/article/001939.htm
• MedlinePlus. Make the most of your doctor visit. U.S. National Library of Medicine. https://medlineplus.gov/ency/patientinstructions/000860.htm
• MedlinePlus. Talking with your doctor. U.S. National Library of Medicine. https://medlineplus.gov/talkingwithyourdoctor.html
• National Institute on Aging. Talking with your doctor: A guide for older adults. https://order.nia.nih.gov/publication/talking-with-your-doctor-a-guide-for-older-adults
• Albarqi MN. Continuity and sustainability of care in family medicine: Assessing its association with quality of life and health outcomes in older populations – a systematic review. PLOS One. 2024;19(12):e0299283. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0299283
• Schuldt R, Jinnett K. Barriers accessing specialty care in the United States: a patient perspective. BMC Health Services Research. 2024;24:1549. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-024-11921-0
• Graetz I. Role and limitations of telemedicine in addressing specialty care access disparities – From promise to practice. JAMA Network Open. 2025;8(5):e2511559. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2834265
• Care Coordination. Agency for Healthcare Research and Quality. https://www.ahrq.gov/ncepcr/care/coordination.html
• About the Health Center Program. Bureau of Primary Health Care, Health Resources and Services Administration. https://bphc.hrsa.gov/about-health-center-program
• Telehealth: What is it, how to prepare, is it covered? National Institute on Aging. https://www.nia.nih.gov/health/medical-care-and-appointments/telehealth-what-it-how-prepare-it-covered
• Understood Care. Appointments. https://understoodcare.com/care-types/appointments
• Understood Care. Care Coordination. https://understoodcare.com/care-types/care-coordination
• Understood Care. Transportation Help. https://understoodcare.com/care-types/transportation-help‍

This content is educational and is not a substitute for medical advice. Always consult your healthcare provider for personalized care.