Simple Tips for Navigating the Healthcare System

Jungle, confusing, costly, too much red tape. These are all words or phrases that have been used to describe the American healthcare system.  Yes, at times it may seem daunting to navigate. The thought has crossed my mind that there should be a required class in college or even high school – Healthcare 101: Navigating the Basics.  Anyway, until then, here are just a few short tips from my professional and personal experiences.  These are in no particular order and a few of them only apply if you have insurance through an employer.  Feel free to add any additional tips you may have under comments at the end of this blog.  Let’s help each other survive the jungle!

 1.  Obtain copies of your labwork and any radiology reports, especially if you know you are going to be seeing multiple doctors for the same issue. Most every physician office has electronic medical records now and there are many benefits to that. However, an EMR at Dr. Jones’ office may not able to communicate with the EMR at Dr. Smith’s office.  So already having copies of your records comes in handy if you need to see another doctor for some reason.  Being signed up on a patient portal makes this process easier.  You can just print or copy and paste records and send them in an email.  Of course you can always have your doctor’s office transfer the records.

2.      If you don’t want to have to wait for long periods to see the doctor, schedule your appointment for first thing in the morning or right after lunch.  There will be a greater chance of him being on schedule.  As the day goes on, it is more likely the doctor may get behind.

3.      Don’t assume your insurance doesn’t cover something.  I assumed my insurance did not cover acupuncture and I paid full price out of pocket for months.  My kind acupuncturist turned my visits into insurance and then much to my delight sent me a hefty check in the mail!  You can find specific information like this in your insurance plan document.  This document is quite lengthy – around 50 to over 100 pages long.  If you have insurance through your place of work, your employer usually does not give you a paper copy.  However, you should have access to it online.  If you don’t know how to access your insurance information online, contact your HR department. Once you bring it up online, simply search the document by using control “F.”  Then type in the box what you are looking for.  I did this with my plan document and sure enough there it was.  Acupuncture was covered under chiropractic care up to 12 visits/year with only a $20 copay/visit.

4.      Let’s face it.  Not everybody likes everybody.  The same goes with you and your doctor.  If you don’t really care for him or her, don’t be afraid to switch to a different doctor.  You don’t have to even go to a different office if there are others to choose from in the same practice.  I had worked in a physician’s office for years with ten different practitioners.  All were highly competent, but they had different personalities. It was not a problem to switch a patient to another doctor at their request. 

5.      I know it stinks when your favorite doctor decides to move to a different city or retires.  If you find yourself in a situation where you need to find a new one, do your homework.  Through the Federation of State Medical Boards, you can do a search via docinfo.org.  This will tell you where your doctor went to medical school, the year she graduated, and if she has been disciplined by the licensing board.  Read reviews, although not always accurate or reliable.  Ask your neighbors, coworkers, family, and friends who they recommend.  Don’t be afraid to call the doctor’s office and ask questions especially if you have chronic medical conditions.  You want to be sure that the physician you choose has experience in what you may be dealing with.

6.      Write down questions before your appointment and take them with you.  If you are newly diagnosed with something or have multiple medical issues, don’t hesitate to bring along a trusted family member or friend.  She can be an extra set of ears and even jot down some notes during your visit.

7.      If your network does not have a doctor in the specialty you are needing, don’t give up thinking you will have to pay big bucks to see someone out of network.  Review your plan document (see #3) or contact your insurance company.  Let them know your situation.  Often times if there is not a specific specialist you are needing in your network, they will not charge anymore for an out of network specialist.  I have worked for an insurance company and the Medical Management department worked hard to do what they could so the patient could receive the best care possible. 

8.      Don’t get too upset with your insurance company if they do not cover something.  Note that the insurance company is bound by your employer’s plan document. Many stipulations in your plan are dictated by your employer, not the insurance company.  One employer may cover something while another employer does not, but they both have the same insurance carrier. The same goes for prior authorizations.  Some employers require an authorization for simple things like an MRI, other employers do not. 

9.      If it is after hours and you are not sure if your symptoms warrant a trip to the Emergency Department, contact your doctor’s office.  They should have a recording that will instruct you on how to get a hold of the physician on call or the after hours call center.  I worked in a pediatric office for years and did some on call work after hours.  Most of the calls I received were able to be taken care of over the phone.  That saved time, money, and more importantly saved the child from being exposed to all kinds of things in the ER.  Obviously use common sense though.  If you have something you feel is life-threatening, contact Emergency Medical Services.

10.   Here’s a simple one.  Bring a list of your medications (over-the-counter and prescription) and supplements to your doctor’s appointment. Every doctor needs to know all medications you are on, not just the ones he or she prescribes. There are many medications that interact with other medications and supplements that interact with medications. 

11.   If you come across misinformation in your medical record, you have the right to request it to be changed.  This falls under HIPAA  (Health Insurance Portability and Accountability Act). Here’s an example.  I obtained a visit note from a provider so I could send it to the doctor she was referring me to (since her office was having problems faxing it).  After reading my visit note, I was shocked! There was a full blown physical exam documented even though an exam was not done. Also, there were symptoms documented that I did not have such as joint pain and headaches.  This false information could have had a significant effect on my diagnosis and care. They fixed their mistakes at my request.  Just a word of caution, if you don’t have any medical background, you may want someone who does to review any records with you.  Medical terminology can be confusing.

12.   Don’t pay your hospital or any medical bill immediately even if you know you have not met your deductible.  Be sure it has gone through insurance first. The insurance company most likely has contracted rates that will be lower than what you are initially billed.

13.   Hold on to any bills and insurance claims. Review them. Double check before forking out the big bucks!  I have saved hundreds of dollars by staying vigilant.

14.   Don’t expect ER to cure your chronic problem.  They are there to make sure you are not in immediate danger and stabilize you until your doctor’s office is open or admit you to the hospital if further monitoring or treatment is needed. 

15.   The previous tip leads me to this one.  Be sure you have a primary care practitioner (MD, DO, NP, or PA) Yes, even if you are healthy and never get sick.  This way, when you do get sick (and you will at some point), you already are established with a physician.

16.   Take advantage of your wellness benefits.  These are covered 100% without a copay!  They usually include a yearly check-up, certain health screenings (such as mammograms, blood work like cholesterol, glucose and more).  Contact your insurance company or employer to find out what wellness benefits are included in your plan. Some employers cover more than what is required by the Affordable Care Act.

I could go on, but then this will turn into a 3 hour credit college class!  Again, feel free to share with others below any tips you find helpful.

Remember: It’s your body, your health, your life.  YOU are your best advocate!

Coming up in my next blog:  Meet Epstein-Barr, the Sleeping Giant In Us All!

Best in Wellness,

Marianne

  Share your comments below or contact me directly at  mrbush1990@gmail.com


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Disclaimer:  This blog is not intended to diagnose, treat, cure, or prevent any disease.  It does not replace the medical advice of a physician.  The readers should regularly consult with their primary care practitioner in matters relating to health, disease, and/or symptoms. The information on this site is for educational purposes only. It is recommended you speak with your primary care provider before making any lifestyle changes.