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The New Healthcare Challenges-Ignorance Is Not Bliss !

Updated on February 7, 2018

Is Healthcare Changing ?

In decades past, healthcare was easy ! You knew your family doctor and for the most part he took care of you all your life. You knew your doctor and he knew you. Now, the healthcare system is complicated, no matter what kind of healthcare insurance coverage that you have or have not. When you call a physicians office, in many cases, the first thing an office or hospital will ask is "What insurance do you have". Getting the right healthcare for your condition or situation can be tricky. Not understanding your policy or coverage can literally place you in a heavy debt that you may never have seen coming ! You must be a consumer as much for your healthcare as you would be when you make a major purchase like a car or a washing machine. You would not want to be confronted with the shock of a large debt when you are trying to get your broken leg fixed !

Who are you seeing for your healthcare?

If you don't have a regular physician who takes care of you when you appear in the emergency room more than likely, you will be treated to the specialist on call for that day. That means that you will be under the care of a doctor who has never met you or does not have access to any information about you. Should you have a physician that you see on a regular basis that doctor will have additional input if the emergency doctor wants to admit you to the hospital.

When you are a new patient to a doctor, or have never asked your current physician, inquire the use of a hospitalist if you are admitted to a hospital. It is more common for doctors not to do hospital visits. Instead, they use specialists called hospitalists. This is not necessarily a bad thing, depending on the training of the doctor covering you while you are in the hospital. It's just important for you to know who you will be seeing. Ask your physician or healthcare provider how or if the hospitalist communicates with them.

Will you be seeing a nurse practioner, a physician assistant or the doctor within the practice. If the doctor has a nurse practioner or a physicians assistant, what defines when you see the doctor or other staff members? Ask questions how the practice operates so that you understand how your healthcare will be provded

Who Provides Your Primary Health Care Coverage

See results

What Kind Of Healthcare Providers Are There

  • Primary Physician:
  • Hospitalist
  • Specialist
  • Resident:
  • Physician Assistant:
  • Nurse Practisioner:

Know Your Insurance ! Know Your Healthcare Options

It's important to know several points of your insurance coverage when it comes to your primary physician, your specialists, your emergency room care and your in hospital care.

  • Understand any deductible charges: You can think of deductibles as the charges you pay from your pocket. You may have deductibles when you see your doctor. go to the emergency room, or become a hospital inpatient. It's important to know when your deductibles apply and how much they actually are. For example, you might have a $500 deductible for an emergency room visit. That means that when you go to the ER they will expect a $500 payment. You might have a $20 copayment every time that you see your physician. You get the idea. Always know what your deductibles are or you will have a nasty surprise when you use services
  • Know what's covered and what's not: You might have the idea that everything you need for your medical situations is covered. But that's not always true. Some items may have only limited coverage and some no coverage at all. It's important to know what is covered and how it will be
  • Do you need pre-approval for a test or treatment? Many times your insurance requires a pre-approval for a certain kind of test, specialists visit or treatment. If you opt to go ahead without that pre-approval, that expense will be an out of pocket expense for sure.
  • Understand the appeal process of your insurance carrier ! Many times there is a clerk at your insurance company making decisions about procedures, tests and specialists based on information that your doctor or health care provider sends to them. If a wrong code attached to your paperwork as the reason for this expense is transposed, you can easily receive a refusal of expenses. Knowing the appeal procedure can mean the difference in your health. Never take no for an answer until you have at least asked why one or more times !
  • Understand your prescription coverage: Many policies have separate prescription policies. Others are included within a complete policy. Understand what and how your insurance policy covers your medications. Know what pharmacies you can use and what kind of meds are covered. Know what and how generics verses name brands are dealt with in your policy. Otherwise, you may have a large surprise when your pharmacy hands you an unexpected bill for a small container of pills

Type Of Healthcare Provider
Education Or Requirements
What They Can Do
Primary Doctor, Internist Generalist
Either an MD (Doctor Of Medicine) or a DO (Doctor of Osteopathy
Operate a general practice in family medicine, internal medicine or pediatrics
Specialist
Either an MD (Doctor of Medicine) or a DO (Doctor of Osteopathy) Usually has a fellowship in his specialty
Sees patients in thier office, does in office minor surgery, does surgery in hospitals and follows up patients
Nurse Practioner (NP)
A nurse with graduate training
Can provide care as primary care providers, pediatrics, mature adults(geriatrics), adults and women's health
Physician's Assistant
Individuals who have taken extensive clinical and educational training similar to but less than a physician
Can order tests, do examinations, order medications, do procedures, ect under the supervision of a licensed physician

Ignorance Is Not Bliss When It Comes To Your Health Insurance

It doesn't matter if you are insured through your employer, Medicare or Obamacare. The point is that you need to know what your insurance pays, how much it pays, when it pays and how it pays. Ignorance is not bliss when it comes to your health care. Understanding your policy and coverage is important ahead of time before something happens and you are in a position where you have to make a decision that influences your pocketbook and your health. Always feel comfortable asking your doctor or healthcare provider about alternatives to any treatment, medication and tests that may be ordered-especially if you are paying out of pocket expenses. Being prepared can save you money and make a difference in your outcome

© 2014 Linda F Correa

Weigh In On How To Be A Better Healthcare Consumer?

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    • linfcor profile imageAUTHOR

      Linda F Correa 

      4 years ago from Spring Hill Florida

      People are always so shocked when they get their bills or someone asks them for upfront money for a deductible. You wouldn't let a mechanic do work without knowing how much it was going to cost you. Why don't we ask the same questions of our health care providers?

    • SheGetsCreative profile image

      Angela F 

      4 years ago from Seattle, WA

      Good advice. I'd also add you have to read your EOBs religiously. I just helped someone straighten out a 2-year mess because her insurance had been billed incorrectly (primary vs secondary) and she was actually sent to collections. In the end, they owed her money and are now having to provide documentation to get her credit score reinstated.

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