Consumer's Guide to Healthcare Providers
- Selecting a healthcare provider
- How to find a doctor
- How to find a dentist
- How to find a mental health provide
- How to select a hospital
- How to select a nursing home
Today's consumers have a wide range of choices in healthcare, from traditional medical care to "alternative" practices such as naturopathic and acupuncture. Because there are so many choices, it's more important than ever for consumers to be well-informed. Your health—and your money—depend on it.
Various entities of the California Department of Consumer Affairs license and regulate more than 19 different types of healthcare professionals, from physicians and surgeons and registered nurses to hearing aid dispensers, psychologists, and others. More than 900,000 healthcare professionals are licensed in California by the various entities of the Department of Consumer Affairs.
In addition to State licensing, some professional organizations offer certification, such as Board certification for physicians and surgeons, that can indicate a higher level of knowledge and expertise than the minimum level required for a State license. Those organizations set their own standards and their own methods for determining if someone meets those standards.
In your lifetime, you may not need all the types of licensed healthcare professionals listed in this guide, but it's important to know who they are and what they do. Licensed professionals must meet minimum standards for education, training, and experience. In all cases, applicants for State licensing must pass appropriate professional exams and criminal background checks. You can check licenses online at www.dca.ca.gov. Click on "consumers" then on "license verification."
The following are general descriptions of each type of healthcare professional. Additional details are available from the licensing entity listed with each description. Each licensing entity also has information available online or by phone on how to verify a healthcare professional's license and file a complaint.
Acupuncturists treat health conditions by stimulating "acu-points" on the body. Acupuncturists do this by inserting very thin needles through the skin, or by using heat or finger pressure. Acupuncture Board of California, 916.445.3021.
Audiologists evaluate, diagnose, treat, and manage hearing loss and balance disorders in adults and children. An audiologist must hold a doctoral degree in audiology or a related field. Some audiologists also fit and sell hearing aids. Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board 916.263.2666.
Chiropractors diagnose and treat patients with problems of the musculoskeletal system and treat the effects of those problems on the nervous system and on general health. Many chiropractic treatments deal specifically with the spine and the manipulation of the spine. Board of Chiropractic Examiners, 916.263.5355.
NOTE: The Board of Chiropractic Examiners is not an entity of the Department of Consumer Affairs.
Clinical social workers
Licensed clinical social workers (LCSWs) are employed in health facilities, private practice, and child welfare agencies. They use counseling and psychotherapeutic techniques to assist individuals, couples, families, and groups. LCSWs often refer clients to specific resources to improve their quality of life. Board of Behavioral Sciences, 916.574.7830.
Contact/spectacle lens dispensers
A contact lens dispenser is authorized to fit and adjust contact lenses. A spectacle lens dispenser is authorized to fit and adjust eyeglasses. Both must by registered by the Medical Board of California. A technician who fits or adjusts contacts or glasses under the supervision of a physician or optometrist does not need to be registered. Medical Board of California, 800.633.2322.
This classification includes unlicensed dental assistants, registered dental assistants, and orthodontic assistants. All of them perform basic supportive dental procedures under the supervision of a licensed dentist or licensed dental hygienist. Dental Board of California, 877.729.7789, 916.263.2300.
Dental hygienists clean teeth and provide preventive dental care, as well as teach patients how to practice good oral hygiene. Dental Hygiene Committee of California, 916.263.1978.
Dentists diagnose and treat diseases, injuries, and malformations of the teeth, jaw, and mouth. Dentists can specialize in orthodontics, pediatric dentistry, or periodontics. Dentists who hold an "elective facial cosmetic surgery" permit may perform certain facial cosmetic surgery procedures. Dental Board of California, 877.729.7789, 916.263.2300.
Educational psychologists work in schools or in private practice and provide educational counseling services such as aptitude and achievement testing or psychological testing. Educational psychologists cannot do psychological testing or counseling that is unrelated to academic learning processes in the education system and cannot prescribe drugs. Board of Behavioral Sciences, 916.574.7830.
Hearing aid dispensers
Hearing aid dispensers fit or sell hearing aids. Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board, 916.263.2666.
Marriage and family therapists
Marriage and family therapists are employed in clinics, counseling centers, and private practice. They use counseling or psychotherapeutic techniques to assist individuals, couples, families, and groups with a focus on marriage, family, and relationship issues. Board of Behavioral Sciences, 916.574.7830.
A midwife licensed by the Medical Board of California is authorized to attend cases of normal childbirth in a home, birthing clinic, or hospital, under the supervision of a licensed physician. Certified nurse midwives, who are under the jurisdiction of the Board of Registered Nursing, perform similar duties. Medical Board of California, 800.633.2322, 916.263.2393; Board of Registered Nursing, 916.322.3350.
Naturopathic doctors are primary care providers who diagnose and treat acute and chronic conditions. They use herbs, supplements, vitamins, homeopathic, nutritional counseling, some prescription medicines, and other treatments to help the body heal itself. Naturopathic Medicine Committee, 916.928.4785.
Nurse practitioners are registered nurses who have additional education and training in physical diagnosis, psychosocial assessment, and management of health or illness needs. They help manage acute and chronic conditions, furnish medications, and educate and counsel patients on healthcare matters. Board of Registered Nursing, 916.322.3350.
Occupational therapists use physical exercises and activities with children and adults to help them live better with illness, injury, or disability. Occupational therapy can also include recommendations for adaptive equipment and training on its use. Board of Occupational Therapy, 916.263.2294.
Ophthalmologists are eye surgeons who perform surgeries for problems caused by diseases such as cataracts, glaucoma, and macular degeneration. They can also treat eye diseases and prescribe corrective lenses. Medical Board of California, 800.633.2322.
Registered dispensing opticians run businesses that fill prescriptions for eyeglasses and contact lenses. Opticians cannot prescribe corrective lenses. Medical Board of California, 800.633.2322, 916.263.2341.
Optometrists conduct examinations to determine the overall health of the eyes. Optometrists screen for diseases such as glaucoma, cataracts, macular degeneration, hypertensive retinopathy, and diabetic retinopathy. They also prescribe corrective lenses (glasses and contact lenses) when needed. Board of Optometry, 916.575.7170, 866.585.2666.
Osteopathic doctors are trained and licensed to prescribe medicine and perform surgery, similar to medical doctors. An osteopathic doctor puts special emphasis on the role of the bones, muscles, and joints in the healthy functioning of the body. Osteopathic Medical Board of California, 916.928.8390.
Pharmacists dispense prescribed drugs to individuals. They also advise patients and healthcare professionals on the selection, dosages, interactions, and side effects of medications. California State Board of Pharmacy, 916.574.7900.
Pharmacy technicians provide administrative or technical support and customer service. They work under the supervision of pharmacists. California State Board of Pharmacy, 916.574.7900.
Physical therapists administer treatments to relieve pain, improve movement, maintain cardiopulmonary function, and limit disabilities. Physical Therapy Board of California, 916.561.8200.
Physicians and surgeons
Physicians and surgeons are medical doctors who practice in a wide variety of specialties. Medical Board of California, 800.633.2322.
Physician assistants practice medicine as a team with their supervising physician. Physician Assistant Board, 916.561.8780.
Podiatric medical doctors
Doctors of podiatric medicine (DPMs) are trained to diagnose and treat conditions affecting the foot, ankle, and related structures of the leg by all available means. California Board of Podiatric Medicine, 916.263.2647.
Psychiatric technicians practice under a physician, psychologist, registered nurse, social worker, or other related professional. They work at State hospitals, day treatment centers, and residential care facilities. Board of Vocational Nursing and Psychiatric Technicians, 916.263.7800.
Psychiatrists are physicians who specialize in prevention, diagnosis, and treatments of mental disorders and are authorized to prescribe medication. They work in private practice, hospitals, and clinics. Medical Board of California, 800.633.2322.
Psychologists provide mental health care in hospitals, clinics, counseling centers, or private practice. They provide individual, family, or group psychotherapy and may design and implement behavior modification programs. A psychologist has a doctoral degree in psychology, but is not a physician and cannot prescribe medication. Board of Psychology, 866.503.3221, 916.263.2699.
Registered nurses (RN s) provide care that ensures patient safety, comfort, personal hygiene, protection, and disease prevention. RN s also administer medications prescribed by a physician, dentist, or other authorized healthcare provider. Board of Registered Nursing, 916.322.3350.
Respiratory therapists treat lung and breathing disorders. They consult with physicians, analyze tissue and blood samples, and manage artificial breathing devices for patients who cannot breathe on their own. They are specialists in airway management, mechanical ventilation, and acidbase balance. They also conduct asthma education and smoking cessation programs. Respiratory Care Board of California, 866.375.0386, 916.323.9983.
Speech-language pathologists screen, assess, and treat adults and children who have speech, language, or swallowing disorders. Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board, 916.263.2666.
Licensed vocational nurses provide patient care under the supervision of a physician and surgeon or registered nurse. Board of Vocational Nursing and Psychiatric Technicians, 916.263.7800.
HOW TO FIND A DOCTOR
Selecting a doctor for yourself or your loved ones often begins with your health plan. A health maintenance organization (HMO) will have a list of doctors and instructions on how to select one. A Preferred Provider Plan (PPO) will offer more choices, but doctors who are outside the plan will cost you more out of pocket. To find a doctor or other healthcare professional who accepts Medicare, go online to the Centers for Medicare and Medicaid Services.
Tips from the Medical Board of California
- If you have health insurance, the first place to check is with your insurer or your employer's benefits office. Many insurance plans limit your choice to a list of doctors who agree to certain requirements. Many plans also require you to select a primary care physician from their list. The primary care physician is then responsible for your care and must make any necessary referrals to specialists or other health professionals.
- If you are not limited to a list of doctors, most doctors are listed in your local telephone directory. For your doctor, you should consider a family physician or internal medicine specialist (internist). Women may want to choose an obstetrician/gynecologist. Parents may want to select a pediatrician for their children. All of these doctors are considered primary care physicians and can provide overall healthcare management. Be sure your insurance plan will cover the doctor's services before you incur any charges.
- You may want to talk with friends or co-workers about physicians they like. Most county medical societies will also give you names of physicians in your area who are in the specialty you select. Look in the white pages of your phone directory for your county medical society or association.
- Once you have some names, call the doctors and ask if they are accepting new patients. Be sure to ask whether they will accept your insurance plan.
- Ideally, you should meet the doctor and discuss your health concerns while you are well. This may be a good time to have a history and physical examination performed, but, again, make sure your insurance will cover the cost. Most plans will not cover an informal visit just to get acquainted.
- Before you make an appointment, call the Medical Board of California at 800.633.2322 or go online to www.mbc.ca.gov to verify that the doctor has a current California license.
- Board specialty certification is granted by the American Board of Medical Specialties or other similar private entity. Find links to similar organizations at www.mbc.ca.gov/consumer/board_certified.html.
- For information on Board certification for doctors of podiatric medicine, visit the Web site of the American Podiatric Medical Association.
- For help finding an osteopathic doctor, go online to Osteopathic Physicians and Surgeons of California Web site.
HOW TO FIND A DENTIST
If you are covered by a dental insurance plan, contact your provider for a list of dentists that accept your coverage. The California Dental Association maintains an online directory that can help you find a dentist in your area. Find the directory at www.cda.org. When you have the names of a specific dentists you are interested in, confirm their licenses with the Dental Board of California, 877.729.7789 or 916.263.2300.
HOW TO FIND A MENTAL HEALTH PROVIDER
The Board of Behavioral Sciences has a list of resources to help you find mental health services. You can find the list online at www.bbs.ca.gov/consumer/find_services.shtml.
For Your Peace of Mind, a publication from the California Board of Psychology, includes tips on selecting a mental health professional. View the publication online at www.psychboard.ca.gov/formspubs/consumer_guide.pdf.
HOW TO SELECT A HOSPITAL
The doctor who is treating you may decide which hospital is appropriate for your care. Even if you don't choose the hospital yourself, you may wish to check on how the hospital is rated by the California HealthCare Foundation. More than 240 hospitals, representing 86 percent of acute care hospital admissions in the State, participate in the voluntary ratings. Go online to www.calhospitalcompare.org for the ratings and an explanation.
HOW TO SELECT A NURSING HOME
Medicare's Guide to Choosing a Nursing Home provides information to help individuals and families make informed decisions about nursing home care. The guide is available online at www.medicare.gov/index.html.
Complaints about a licensed healthcare professional should be filed with the appropriate licensing entity. Here are some tips on how to handle complaints about other healthcare matters.
Consumers who have disputes with hospitals about medical care, billing practices, or charges should try to resolve problems by contacting the hospital's management care consultant or patient advocate.
PROBLEMS WITH HMOs
If you have a problem with your health plan or health maintenance organization (HMO), you should contact your health plan first. If you have not received a response to your complaint within 30 days (within three days if the problem is urgent), or if you are not satisfied with your health plan's decision, contact the Help Center at the California Department of Managed Health Care, 888.HMO.2219 or 888.466.2219.
Information on your HMO rights under California law and tips on how to use your health plan are available from the California Office of the Patient Advocate, 866.466.8900.
More than 500,000 people have been victims of medical identity theft in the United States, according to the World Privacy Forum. Some experts say digital medical records may increase the risk. That's all the more reason for consumers to be aware of how medical ID theft occurs and how to prevent it.
- Filing false claims to get payments from health insurance companies and government programs such as Medicare.
- Obtaining prescription medications that are then sold on the black market.
- Obtaining medical treatment, exams, or surgeries under another person's name.
While the first two types are for financial gain, the third type can be dangerous for you. If someone uses your name to obtain medical services, that person's medical information may end up in your file. Your medical record could show you are taking different medications, have different allergies, or even have a different blood type. This kind of misinformation can cause medical personnel to give you treatment or medications which could cause you serious harm.
Another danger of medical ID theft, according to the Federal Trade Commission (FTC ), is that debt collectors could come after you for the scammer's unpaid medical debts. Your credit will suffer if medical bills are not paid.
- First, read the "Explanation of Benefits" statement you get from your health insurer. Follow up on any item you don't recognize.
- At least once a year, ask the health insurers you've been involved with for a list of the benefits they have paid in your name.
- Finally, check your credit reports regularly. You're entitled to a free report from each of the three nationwide credit reporting companies every 12 months. That will help you monitor any unpaid medical bills that are falsely charged to you. You can order your free credit report at https://www.annualcreditreport.com/cra/index.jsp.
The privacy of your healthcare records is protected by a Federal law known as the Health Insurance Portability and Accountability Act (HIPAA). The law applies to certain healthcare providers such as doctors, dentists, chiropractors, and pharmacies. It also covers all health insurance companies and health maintenance organizations (HMOs), company health plans, and government programs that pay for healthcare, including Medicare, Medi-Cal, and military and veterans healthcare programs.
THE LAW IN GENERAL
- Defines your rights over your health information.
- Sets rules and limits on who is allowed to receive and/or view your health information.
The U.S. Department of Health & Human Services has more information on your health information privacy rights. Visit http://www.hhs.gov/ocr/privacy/index.html for details. California laws also cover the confidentiality of medical information. For details, see the Privacy Rights Clearinghouse. More information is also available from the California Office of Health Information Integrity.
If you think you may be a victim of medical identity theft, ask your healthcare provider or hospital for your medical records. You have a right to get copies of your current medical files from each healthcare provider, though you may have to pay for the cost of making copies. Charges should be minimal.
For tips on how to prevent Medicare fraud and what to do if you suspect you may have been a victim, visit www.StopMedicareFraud.gov or call 800.HHS.Tips or 800.447.8477.
In the marketplace, a well-informed consumer is a well-armed consumer. The same is true for consumers of healthcare. A wide range of information on healthcare professionals and institutions is available to help you make the best healthcare choices and decisions for yourself and your loved ones. The next step is up to you.