HOW TO BE A WISE HEALTHCARE CONSUMER

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    With the rising costs of health care and the complexities of health care treatment, it is more important than ever for you to become a proactive and informed advocate for your own health care.

    Being informed and questioning the care you receive can help avoid unnecessary costs and can help prevent unsafe outcomes. The health care decisions you make during the year affect your out-of-pocket costs and the long-term cost of your health plan.

    Physicians and other medical providers are trained experts, and they generally have your best interest at heart. Therefore, it is not recommended that you ignore their advice or avoid seeking medical treatment. Instead, you should become as informed as possible and ask lots of questions to better understand the treatments so you can be part of the decision. In some cases, your questions may lead to a discussion of better, more cost-effective alternatives. And finally, by being informed and proactive, you will be taking an active role in your own health and health care treatments which can only lead to better outcomes.

    Good Health Begins With You

    Taking good care of your health will improve the quality of your life and will save you costly medical treatments.

    • Start with making important lifestyle changes such as quitting smoking, eating better, losing weight, limiting alcohol use and exercising regularly. If you need support, reach out to your physician, family and friends.
    • Prevention is key. Early detection is critical. Follow recommended guidelines for periodic health screenings and tests. When you delay treatment, it is typically more costly and the outcomes are less satisfactory. The recommended frequency of your preventive medical tests and exams will depend on your age, gender and medical history. Work with your physician to determine a schedule and review it with him or her every few years.

    Select the Right Physician

    With so many doctors available, how do you select the right one for you? You should start with the list of network physicians for your health plan, which is normally available online. Determine if the doctor is accepting new patients and then consider the following:

    • Are there any complaints filed against the doctor on record with the State Medical Society?
    • Is the doctor recommended by anyone you know?
    • Does the hospital(s) at which the doctor has privileges meet the requirements of both your insurance and your convenience?
    • Does the doctor have a pleasant manner, listen attentively and respond to questions?
    • Does the doctor offer lab work or other services in the office?
    • How long is the wait list for a first appointment?
    • Does the doctor publish a fee schedule?
    • Is the office located in an area that is convenient, with plenty of parking or public transportation?

    When Visiting the Doctor

    A doctor’s visit can lead to discussions about health conditions and treatments. This is an important time to be proactive and engaged in your own health care.

    • Know ahead of time what your plan covers by reading the plan documents.
    • Ask questions about proposed treatments, test, etc. What are the costs associated with these? Ask if there are cheaper alternatives that accomplish the same thing.
    • You have the right to question anyone who is involved in your care. Beware of any doctor who is unwilling to answer your questions or take the time to explain tests or treatments. Remember, you have a choice which doctor you see!
    • Come prepared with a written list of symptoms and/or questions. In fact, it’s a good idea to have a small health notebook you take with you each visit to take notes. This will be a good place to centralize notes on symptoms, progress during treatments and information gained during the doctor visit.
    • Discuss prevention and preventative tests with your doctor (e.g. mammograms, physicals, etc). Learn all you can from your doctor about what you can do to achieve optimal health.

    Evaluate Your Course of Treatment

    Each doctor visit, prescription and treatment plan presents you with choices and responsibilities. Here are some important things to keep in mind:

    • Make sure your doctor fully explains any test, prescription or treatment plan they are recommending. Ask lots of questions and take notes to help you remember details when you get home.
    • For prescriptions, always inquire about generics. These are exactly the same as name brand formulations and can save you money.
    • Get a second opinion if surgery is proposed.
    • If a diagnosis or treatment recommendation makes you uneasy, slow down. Ask your doctor to explain things more and give you clear options. Make sure you know all of the alternatives as well as the risks and benefits. Consider pursuing a second opinion for peace of mind.
    • It is a good idea to have a family member or friend with you, especially when dealing with a health condition requiring treatment. This person can help listen and ask questions so that you leave with all the information you need.
    • Use the Internet as a resource, not an authority. Online information can be helpful, but you should also question who is paying for the information you are seeing, verify the credibility of the source and always discuss what you learned with your doctor.

    Monitor Your Insurance Plan and Health Care Costs

    It’s tempting to just pay your premiums and co-pays and ignore the rest of the paperwork related to your insurance claims until some problem comes to your attention. You play an important role in helping to detect billing errors, and in rare cases, medical fraud. The easiest way to do this is through timely review of all insurance plan correspondence.

    • Before you leave the doctor’s office, review the medical bill they provide you and be sure it reflects the services you actually received. Ask the staff to explain any notes or codes you don’t understand.
    • Save the medical bill and receipt from your office/hospital visits.
    • Immediately open that envelope from your insurance provider. It likely contains an Explanation of Benefits (EOB) that shows how much of the claim will be paid, how much you are responsible for, how much of your deductible you have met, etc.
    • Compare your medical bills to the EOBs. Look for errors and report these to your provider and insurance company.
    • Contact your insurance company with anything that looks unusual or anything you don’t understand.