Take Control of Your Health Care, Well- Being, Sanity and Budget
Only you can be personally invested in your health
There is much talk and debate about our healthcare system in America, most of it centering on cost and how to cover the uninsured. From a patients perspective, we also see other major issues in communications, understaffed clinics, follow through, waste, and our dwindling savings account even with good health insurance. This leaves most patients vulnerable unless they or someone in their family takes control of their own health and well being, organizes themselves and asks the obvious questions.
We expect our healthcare professionals to be the most up to date and use technology to communicate a seamless process through a major medical crisis; the patient must realize this likely won’t be the case if you get caught in the maze of being refereed to other specialists.
We also expect referrals to specialists and other medical and diagnostic services to be of the best interest to the patient. This may also not be the case if those services are provided as a network of common ownership interest. Here it is not so much about the quality of those particular services, as each one follows strict guidelines, but more about the cost, time and stress on the patient, whereas like services might be more convenient and less expensive. You have a choice in your healthcare services, unless you are in a tightly managed care insurance program.
As I see it and have personally experienced, there are really three major underlining issues in today’s broken healthcare system: time, constraints by insurance companies, including Medicare, and the fear of being sued. Most physician practices have become extremely busy because of population growth, physician shortages, and the need to see more patients per day just to keep up with their office overhead, overheads primarily caused by the increase in liability insurance, being spurred on by more lawsuits, and high dollar jury awards. Insurance and Medicare has cut their billable time based on diagnosis. If they spend more time beyond the allotted billable visit they are cutting into revenues that can be generated by seeing the next patient down the hallway.
In these times it’s best to find a good primary physician and stick with them. They will have your ongoing medical history and be more willing to spend the time with someone they know will be long term, rather spend time with someone who just drops in once and out the door, never to be seen again. Beyond the initial visit the doctors' office has to open a medical record on you and keep it for many years depending on your state.
Many physicians are adding nurse practitioners and other physician extenders, just to increase their billable patient flow. For the patient this means you only have a very brief period of time to explain your symptoms, and they determine if the symptoms are potentially serious enough to even get in front of a doctor.
It is best to come organized: write down your allergies, symptoms, frequency, current medications/doses, and if your symptoms may be related to blood pressure, if you have time--try and take a diary of blood pressure readings with you. Let the office person who checks you in know specifically why you are there, even if it may be embarrassing information that you only want to share with the doctor. They are not making idle chit chat, they are trained to triage or route who needs to see the doctor and who will be seen by the nurse practitioner. The new home based electronic blood pressure machines are easy to use, they may not always be accurate but at least they will provide a base line for your healthcare professional to consider. Also write down any questions you may have, even if they seem minor, as you may forget and won't remember until the doctor is out the door and on to the next patient.
Take control of your time. If you do not the doctor’s office staff will want you to give up a large part of your day in order to accommodate a doctor to see you for only 10 to 15 minutes. When making an appointment, ask if there is any particular day of the week that is less busy and try make your appointment on the way to or from work, but still expect that the office staff will over schedule to keep the flow of patients coming through the door.
Making the appointment when the office opens might be a good time for instance, as you won’t likely get caught in the morning backlog. Then again, if your doctor has rounds at the hospital before coming to the office, this might not be the best option either as they will likely always be late.
Get to know your doctors office staff and try to make a lasting, favorable impression. They are the ones who will help you get a prescription called into the pharmacy without having to come in, or they will go out of their way to help you squeeze in a last minute visit if you develop a good connection with them. If you have special gift baskets to give to some people during the holidays, these are the ones that should be on the list.
One of my pet peeves is spending all my time waiting in the doctor’s office with other sick people to just get a prescription for blood work and then having to make another appointment to waste another day to go back and discuss the results. I now call ahead to my office friends and have the doctor write me a script, go do my blood work and then the doctor has the results in front of them for only one visit. Or if it is going to be a routine ongoing test I will ask for a script to take home with me so that I can do the blood work a few days ahead of time before the next visit.
Some doctors may not like this because instead of getting to collect my co-pay and charging my insurance for two office visits they only get to charge once, but you know what? I have my own time to consider and not having to wait for an hour or so in a closed in space with sick people just so that a doctor can collect my co-insurance and bill my insurance for another 15 minute visit is pretty important to me.
Also realize that the doctor can only bill most insurance companies for a limited visit and for only one-related diagnosis. Some physicians will become irritated if you want to discuss another issue beyond the initial diagnosis they are billing under. In other words, if you go in with the flu, they are probably not going to be too excited to treat an ingrown toenail in the same visit, and would rather have you schedule another appointment. Some doctors however are accommodating especially if you are a routine patient and have been with them for some time.
My other pet peeve regarding blood and other diagnostic tests is that every time I get referred to a specialist it seems everyone wants my blood, leaving me again running, paying co-pays and having to endure the pain and bruising of being stuck by needles. After I discovered they were all basically after the same test, I simply asked if one lab report could be shared between them, and sure enough they agreed.
Now I go and get stuck once and the lab faxes the results to my primary physician and my specialist. I then have the doctors office fax me one as well. This allows me the opportunity to look over my labs and make my list of questions for my next visit. I will also call the office to be sure they have the lab results before my appointment. Talk about cost savings to the healthcare system--just better coordination of these tests could save the country huge amounts of dollars.
As you know it just doesn’t take much to get referred to a specialist these days either. Because of the potential of liability exposure; your primary physician will want to have a specialist see you or other diagnostic tests to cover their backs. I also keep my lists with me so that I can educate the specialist of all my medications and symptoms. I try to hand carry my x-rays, lab reports or anything else that maybe important. Never expect the communications and your complete medical record to flow over from your primary physician. You will end up waiting, or may have to reschedule because they simply don’t have your history. Some of the specialists in our area can be booked up for months in advance.
I try not to use the Internet to self diagnosis; the Internet is full of quack information that can be very scary, and misleading. It is something the doctor doesn’t want to hear in his or her precious billable time with you is your personal theory based on your Internet search of what might be wrong with you and then having to educate you to why that is probably incorrect information. You also don’t want to get labeled as a hypochondriac, as you may have a very serious issue down the road. I do research the internet, and as I’m reading off my list of symptoms I might simply ask if this might be related to a certain issue, not even mentioning I saw it on the Internet.
What I mostly use the internet for is to check my medications and treatments for potential side effects or contradictions. Like me, if you get caught in the maze of specialists you will likely have different medications being prescribed that may not react well with your other prescriptions or may create other symptoms that need to be communicated back to the physician’s office.
This is another reason to keep a list of your current medications and allergies with you when making these visits. It seems once you are referred to a specialist for an ongoing issue no one is really in charge of the overall picture. The primary physician leaves it up to the specialist, but the specialist is only looking at one particular issue. It is really left up to you to take control of your personal health and keep your primary physician and the specialist in the overall big picture.
If you have already have an allergy or a compromised vital organ, be sure to ask the doctor, and then again the pharmacists how this prescription will work with let’s say a weak heart, kidney, or allergy? These professionals are good at what they do but often will overlook your history, especially if a current issue and is not related. Only you are personally invested to protect your vital organs and overall health.
Try to stay with only one pharmacy; they will likely have your history and medications in the computer system to pop-up red flags. Also if you already have compromised issues seek out the pharmacist to assist you with any over the counter medications that may cause further harm or counteract with your other prescribed medications. Many over the counter medications will actually raise blood pressure, and with ingredients such as Acetaminophen in so many over the counter products can accumulate and cause irreversible liver damage.
If you are trying to save money on your prescriptions, don’t risk your health by shopping between pharmacies to save a buck. You can still take advantage of pharmacy savings prescription plans, especially if they would be cheaper than your co-pay. Just tell them you don’t want to have it billed to the insurance and use their savings plan. Some pharmacies may not like it and some may not let you do it, but many have a long list of routine medications that are actually cheaper to purchase than paying the insurance co-pay. Some pharmacies may also have a price match guarantee.
Most doctor offices are stocked with prescription samples provided by the pharmaceutical companies. Ask if a starter dose maybe available to go along with your prescription. This might be as much as a week or month of medications that will save you from purchasing. If it is a medication you have not taken before, this might be a good way to test and see how you tolerate it before having the script filled.
Don’t get frustrated with your doctor or nurse practitioner if they will not write you a script for an antibiotic, they are actually doing you and society a huge favor. Looking at your ears and throat will help them determine if you need an antibiotic but beyond that and considering viral infections can’t be treated with antibiotics anyway, the most prevailing thought now is to steer away from antibiotic use unless it is just absolutely needed.
For years antibiotics were handed out routinely for everything. In hindsight this is growing into a real worldwide epidemic as the diseases become stronger and even more resistant to antibiotics. These are being called the “Super Bugs” and many have no antibiotics that will touch them. Every time a new stronger antibiotic is introduced the disease figures out how to go around it and our bodies become less immune. Save your immune system for a later time when antibiotics maybe needed to actually save your life.
If you are fortunate to have health insurance, research it closely to see what it pays and how it pays. Getting shuffled from one doctor to another or having diagnostic test may easily place you into an out of network situation, even if you are in the same hospital or office complex. It is always best to have the new provider verify to you that they accept your insurance and are an in network provider for your insurance. Be very specific with your plan and plan number, simply asking if they take Blue Cross and Blue Shield may not mean they accept your specific plan, or you may have higher co-pay amounts. Also have them do a pre-authorization and provide you with an estimate of your out-of-pocket expense. This is one of your patient’s rights to request it. Other surprises or a denial may occur and the doctor office will come to you for payment, having this completed in advance will provide some room to negotiate or have them write it off.
If you have a high deductible for diagnostic test, and you don’t expect to really use it for the rest of the year, perhaps doing a little research may save you some real cash. Many of the independently owned MRI centers will complete an MRI for as little as $500 if paid in advance. If you use your insurance you may have to pay as much a $1500 towards your deductible.
The downside if you will need further healthcare for the rest of the year you will still be subject to meeting you’re out of pocket deductible. With many deductibles now running $3000 to $5000, healthcare is not cheap even if you have insurance. Hospitals and providers will require you to pay them your deductible in advance before having non emergency elective surgery or test completed. This is not new, but what is new in some hospitals regardless of where you have been previously and what you have already paid toward your deductible for the year may not matter to them. They would rather collect the deductible complete the billing to your insurance and refund the difference to you later, especially if all the other providers that you have paid your deductible to are still in the process of doing their billing.
If you don’t have insurance at all, realize the doctor’s office or hospital is going to charge the highest rack rate they have for those services to you as a private pay individual. What this means is that if you check into a luxurious hotel without a discount reservation booked in advance, they are going to charge you the max amount for the room as they have posted. If anything a small min-medical insurance program can at least give you access to pre-negotiated lower rates.
Most hospitals or doctors offices will quickly negotiate down to the Medicare fee schedule or posted state workers comp schedule just simply by asking, even if you are not eligible for them. These are the rates they are routinely paid by Medicare or insurance and they know something is better than nothing. This may be as much as paying only a small % on the dollar for what they will routinely charge a private pay individual.
If you have incurred a huge medical bill you can still try and negotiate payments, simply call the office manager, and tell them you can bring them a check for 30-50% of the amount if they will write off the rest. Depending on how much it is and how long you have owed it, you might be surprised on how many times they will be happy to say yes to your offer. At least this may open the door to negotiate something less than what you owe. You don’t need to pay a third party to negotiate paying your bills.
In summary, in today’s healthcare environment everyone needs to take control of not only their own healthy life style, but their personal welfare and well-being, and if healthcare is ever needed we have to understand our responsibility of our own destiny does not stop at the front door of the healthcare provider.