9.7.23

This report is based on in-depth qualitative research that followed fifteen people covered by insurance plans purchased on state and federal marketplaces as they tried to find in-network diabetes care providers.

Overall, participants in this research struggled to find in-network diabetes care providers who were located close to them and had appointments available in a reasonable timeframe. They felt that there were not enough in-network diabetes care providers covered by their insurance and wanted their plans to include more in-network providers. Participants found the process of searching for providers to be complex, time-consuming, and frustrating. They reported that the search process and delays in getting care negatively affected their physical and mental health, work, relationships, and finances. They cited a need for centralized, continuously updated directories or systems to find prospective providers, check which insurance plans they accept, find their locations, and seamlessly book appointments. 

All fifteen participants in this study were searching for diabetes care providers either because they were newly diagnosed with Type 2 diabetes, had an existing diagnosis but were no longer receiving adequate care from their current provider, or because their current provider no longer accepted their insurance. The participants answered weekly structured prompts from October 3 to November 14, 2022, as they searched for providers, tried to figure out which were in network, and tried to schedule appointments. The methodology section of this report provides more information about how this study was conducted.

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Key Findings

  1. Only one of the fifteen participants successfully scheduled an appointment with an in-network provider that took place during the study. Most participants had already spent time searching for a diabetes care provider prior to the start of this study, including ten who had been searching for three or more months. Nine of the fifteen participants were able to schedule appointments, but only one had his appointment during the study period and said that his provider was in network.  
  2. Of the eight other participants who scheduled appointments, only three knew for sure that the provider was in network. Eight participants made appointments that were scheduled to take place after the study period ended. Three of them knew that the provider would accept their insurance. Four were not sure if the provider would accept their insurance or not, and one knew that the provider would be out of network but scheduled anyway. Seven of those who scheduled nonetheless said it was difficult for them to find a diabetes care provider.
  3. Most participants who scheduled said they would have to wait too long or travel more than one hour each way for their appointment. Six of the nine participants who made appointments said they would have to wait over one month for their appointment. Four of those who scheduled said they would have to travel over an hour to get to the doctor’s office. Some participants made tradeoffs in order to schedule with a provider located closer to them, such as deciding to wait months for an appointment.
  4. The process of searching for an in-network diabetes care provider or delays in getting care negatively affected all participants, impacting their physical and mental health, work, relationships, or finances. Even participants who scheduled appointments reported negative effects. Most said that their productivity at work was affected, either because of unmanaged diabetes symptoms or because of time spent during work searching for and trying to contact providers. Participants also reported mental health impacts of searching and delayed care, including frustration, depression, and anxiety. Seven participants were impacted across all domains: physical and mental health, work, relationships, and finances.
  5. For all participants, whether they scheduled or not, trying to find an in-network diabetes care provider was complex and time-consuming, requiring them to piece together information across a variety of sources. Participants described a continuous cycle of trying to identify providers, checking to see if they would be covered, looking for patient reviews and other information, and trying to book appointments. Many participants expressed frustration at spending hours searching for providers, only to find out that the next available appointment was months away or that the provider they had identified was out of network, leaving them to start searching all over again.
  6. Although six of the participants were unable to schedule appointments, it was not from a lack of trying. Most faced “chronic challenges,” i.e., challenges experienced multiple weeks in a row. Five of the six participants who were unable to schedule appointments spent three or more hours searching every week for three weeks. Only three of those who scheduled spent that much time searching. Those who did not schedule consulted on average about four different sources, while those who scheduled consulted about three. Additionally, five of the six participants who did not schedule experienced at least one challenge chronically.
  7. To facilitate access to in-network diabetes care, participants cited a need for more providers, more providers who would take their insurance, and better systems for scheduling. Participants wanted up-to-date, centralized systems for finding out which providers are in network, which have appointments available, and where they are located. They wanted that information to be integrated into a streamlined system for making appointments. Because they felt there were not enough in-network, conveniently located diabetes care providers with appointments available, some cited the need to train more providers and to incentivize existing providers to travel to patients’ communities. 

Support for this research was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.