These tips will help you navigate a complicated healthcare system – Orange County Register
Navigating the healthcare system can be complicated. The sad reality is that health care is a business, not a service. To get the best care, be persistent (but not rude), persistent, and know your rights. Find out as much as you can; don’t assume you know.
The list below contains hard-earned wisdom from someone who is not a medical professional, but an all-too-frequent consumer of health care – me. This is the list I wish someone had given me years ago, before I started dealing with emergency rooms, weekly doctor’s appointments, and the various specialists needed to manage myself and the multiple immune/autoimmune diseases of my family members.
Prior to your appointment, prioritize your concerns. Have a list of questions, so you won’t forget them when you get there. Do not hesitate to ask them! Use the first date as an interview; you can try someone else if your first visit is not to your liking.
Make lists. Have all your procedures, dates, places, etc. at your fingertips. Don’t try to remember it off the top of your head – you might forget something important that could impact your health right now. Make a list of all your doctors, addresses and phone numbers to give to your provider.
Tell your doctor what has happened in your life since your last visit. Things can change quickly with your condition, so don’t assume your doctor has read your chart and knows everything that’s going on.
Link all the institutions you have attended on the online portal used by many suppliers, MyChart (or any other electronic charting system used by your supplier). Before your appointment, let the office staff know that you have downloaded everything. If the doctor has access, he can see all your records without you sending them. One caveat: sometimes electronic mapping systems don’t communicate with each other, so you may have to go the old fashioned way and bring hard copies of your files.
Bring an up-to-date medication list and dosages at your appointments, which the doctor’s office can photocopy for your file. This saves valuable time. Health care providers need to know all of your medications in case of drug interactions.
If you can, ask someone to accompany you to support you and to help remember what the doctor says. (It may also be helpful to have them take notes.)
Do not water down How are you. Be completely honest if you are having difficulty.
Be nice to the front desk staff. You’re more likely to get a date if you’re nice and grateful rather than mean and mean. Everyone is frustrated and feeling helpless, but they are just doing their job. It’s hard, but be patient.
If you’re new to medical bills, don’t panic. when you receive the first wave of invoices because many times they haven’t gone through the insurance process yet. The $1.6 million bill my family received on a Friday afternoon didn’t turn out to be a reality, but it ruined our entire weekend.
Billing is all about coding – there are over 70,000 codes used in billing – and mistakes are made. Procedure codes complement diagnosis codes by indicating what providers did during an encounter. This is how insurance companies and health care providers determine who gets paid for what. If an Explanation of Benefits (EOB) doesn’t seem right, call your insurance company and ask. It might take several phone calls between the doctor’s billing office and the insurance company to sort something out, but it could save you a lot of money and heartache in the end.
Remember that everything is negotiable. At least to some extent. A doctor’s office or a hospital would rather negotiate than entrust you to a collection agency.
If the patient has any type of episodes — tics, tremors, slurred speech, motor problems, etc. – take a cell phone video of the incidents and show it to the doctor during the appointment.
Do you work in the lab? Ask the lab or any diagnostic location to copy the results from your primary care physician (PCP) if they are performing tests. Ask the doctor to copy your PCP and, if applicable, the referring doctor.
It can take forever to get into a specialist, so make an appointment first and do more research on them afterwards. Even if health care providers tell you not to Google, you’ll find online reviews of doctors that can be helpful. Remember that getting the appointment is essential; you can always cancel it later if circumstances change.
If you see a specific specialist, give them a list of all your illnesses. You can give them a quick overview of each, but focus on what you want them to help you with (their piece of the puzzle). The first date is their fact-finding mission to see how they can help you. Talking to a rheumatologist about your intestinal tract for an hour isn’t going to help your osteoporosis.
Check with your insurance company before you go for an appointment. Make sure the date is networked. (Often the doctor’s office can also tell you this.) If you know they will be performing specific tests such as an MRI, make sure pre-clearance has been taken care of before you go. If you have an HMO and were referred, you won’t have this problem, but check the billing rate. PCPs are usually at a rate compared to what specialists charge.
Insurance companies love to refuse care immediately and hope you’ll give up, but don’t.. If a drug or procedure is declined, ask your doctor for a peer-to-peer. A “peer-to-peer” is when your doctor talks to the insurance company doctor who decided to deny you the drug or procedure. If peer-to-peer doesn’t work, try filing a grievance or appeal with your insurance plan. If all else fails, contact the California Department of Managed Healthcare (916-324-8176) and they can request an independent medical examination.
Not all drugs are the same price. Compare the prices. Plus, using a discount card like GoodRx or joining a prescription plan can save you a lot of money.
Doctors often only have 15 minutes to spend with you; sometimes that just doesn’t seem like enough, especially when you’re overwhelmed with a new or chronic diagnosis. Support groups can be a great resource for connecting with others going through the same thing, and sometimes just knowing you’re not alone helps you feel better.
Karen Kelso, an Orange County-based designer, is the founder of The Real Zebras of Orange County, a support group for people with Ehlers-Danlos Syndrome.