Health Advocate Blog

Knowledge is power! How to be an informed patient

Being a patient can often try one’s patience. From dealing with doctors who don’t always run on time to navigating the complex healthcare system–and, of course, dealing with whatever malady made you feel lousy enough to seek out medical care in the first place–nothing about being a patient ever seems to be easy.

One thing you can do to make the process easier to handle is to try and be an informed patient. Knowledge is power, and with the below tips, you may be able to decrease the feelings of powerlessness that often happen when you’re a patient.

    • Start reading.  Read your benefits booklet, and accompanied benefits materials, very carefully.  Make sure you know what services are covered and your financial responsibility.  Know your preauthorization procedure and who to call with questions.
    • Take advantage of your benefits.  Once you understand what your insurance plan covers, take advantage of these things.  Does insurance cover a yearly physical?  Do it!  Can you do a mail-order plan for your prescriptions, which would save you money on prescription copayments?  Go for it!  Health reform now requires that new health plans cover preventative care at 100%, so why not take advantage of it?
    • Make sure your doctor’s part of the “in” crowd.  Generally, and depending on your coverage, in-network care will be much less expensive for you than out-of-network care would be.  Before scheduling an appointment, call both the provider’s office and the insurance company to make sure that the specific doctor(s) you need to see are in-network with your insurance plan.  Also, ask the receptionist to make a notation on your file that if you have any tests done that require lab or radiology work, you’d like them to be in-network as well.
    • Pre-certify care whenever possible.  Emergencies happen–you won’t be able to pre-certify a broken leg, for instance.  But if your doctor wants you to undergo surgery or other procedures, getting this care pre-approved with your insurance company will save you a lot of money and hassle down the road.
    • Always carry your insurance card with you.  You don’t know when an accident might happen–that’s why they’re called accidents.  Make sure your insurance card is always in your wallet.  If you need to get rushed to the hospital unexpectedly, you or someone accompanying you will have your insurance information readily available, which can simplify and streamline the process of getting you the help you need.
    • Take notes.  When you’re at a doctor’s appointment, you might feel scared and overwhelmed.  That’s why it’s important to write things down while you’re there–later on, you may be able to clearly recall your feelings of being overwhelmed, but you might not remember how many milligrams of vitamin C your doctor recommended, or which over-the-counter decongestant she thought might work for you.
    • Ask questions.  If you don’t understand what the doctor’s talking about, ask.  If you’re unfamiliar with a medicine or treatment your doctor’s recommending, ask about it.  If you are unclear about anything regarding your diagnosis, ask for clarification.  The common theme here is ask.  Your doctor is there to help you, and he wants you to understand what’s going on with your health, so don’t be shy about speaking up and asking questions.
    • Look over your EOBs.  Once you’ve visited the doctor and/or had a procedure or treatment done, your insurance company will mail you an explanation of benefits that will tell you what the insurance company thinks you had done and how much of the cost the insurance will pick up.  Read these carefully and match them up with your doctor bills–there could be errors.  Maybe there was a coding mistake and the insurance company thinks you had a totally different procedure done than what was actually done, which could result in more money out-of-pocket for you.  If you think you’ve found an error, notify your insurance company right away.
    • Understand your insurance benefits appeals process.  Did your insurance company not cover something that you thought was covered?  You can appeal–but you need to understand the process.  By reading over your benefits information, you should be able to find out how that process works and what you’ll need to do to appeal.
  • Know when to ask for help.  You don’t have to do this alone.  Find out if your employer includes an advocacy service such as Health Advocate in your benefits package.  If so, reach out to them for assistance with a variety of issues, such as negotiating a large medical bill, helping you find in-network providers, and much more.  If you don’t have access to an advocacy service through your employer, check out Health Proponent, an advocacy service individuals can use.