The Rise of the Empowered Consumer 3

Today consumers are being asked to take a more active role in their health and healthcare. But to be effective, they need help to understand how the system works and what their role is in the complex world of healthcare.

If we are honest, most of us don’t worry about our health care or how to use the health care system until something happens to us and we are thrust into a complex, fragmented and costly system. By taking the time to learn how the system works and our role in the system before we need it allows us to be in a better position to make informed decisions regarding our health and health care.
In this edition of Nurse Advocate, I  share 10 tips that each of us can use to help us to better understand the complex world of healthcare and our responsibility as consumers of health care.  See how many of these tips you are doing! If you have questions on any of these points, let me know.
  • Use the tools offered to you by your insurance company. When you are enrolled in a healthcare insurance plan, you are usually given a member handbook. If you are not given a hard copy, you might be directed to the company’s website where you can download it.  Regardless of how you get it, the first thing you should do is read it – as it will help you know the benefits offered to you as a member. Being familiar with your policy helps you know how you can use your policy to its full potential. If you have questions, do not hesitate to call your insurance company. The member service line is a good way to get information and have questions answered.  When you call, they will verify that you are a member, so have your insurance card in front of you. Have a notebook so you can take notes. Note the date and time of the call and ask for the name of the person you are talking to. This will help if you have to call back or have a problem. The person you are talking to is also taking notes on what they tell you. Many times they will give you a reference number so if you have to call back the reference number will allow your conversation to be recalled by another member of the member service team.
  • Select a primary care physician or PCP: Having a primary physician that you see on a regular basis allows you to build a relationship with your doctor so they know you and you know them. Your PCP will be the person you go to for your annual physical or when you get a bad cold or experience another problem that drives you to a doctor. Many PCPs are starting to have extended hours and may even have weekend hours so you can see them without taking time off from work. This is an important question you can ask when searching for a primary care physician.
  • Learn where the urgent care centers are in your area. If you can’t get to see your primary care physician in a timely manner, you can go to the urgent care center. Urgent care centers are less expensive than the emergency department. If your symptoms persist, following up with your primary care provider is a must.
  • Start your own file. Get a binder and put all of your paperwork into the binder. Keep in mind, you are the only constant in your care. Over time, most if not all of your providers will change. Keeping good records will help you update new providers as to your history. Whenever you see a doctor or get a diagnostic test, ask for the report so you can share it with your primary doctor and add it to your file. If you get an x-ray, you can get a disc of the actual films so the ordering doctor can see the films themselves. Take your binder with you when you visit your doctor.  Doing so allows you to provide information that your doctor may not have when they see you. Having this information will cut down on fragmentation and duplication.
  • Take time to visit your insurance company website. The website has a wealth of information that can help you learn about how you can take care of yourself and other tidbits you can use to stay healthy. Accessing your insurance company web portal allows you to have access to your medical claims and know what has been paid and what is still pending. It is important to remember that you should not pay any medical claims till your insurance company pays their portion. Once they have paid their portion, you will get an EOB or Estimate of Benefits which shows what the bill was, what the insurance company has paid and what you owe based on your insurance plan. You should also review the bills to make sure what is charged was done. Mistakes can happen, so checking the bills for accuracy is important. 
  • Check to see if your primary care physician has a patient portal as many providers have these portals. They allow you to communicate with your doctor.  This is another tool you should learn about as it enables you to communicate with your doctor and have access to medical records they have added. Most of these sites have technical support to help guide you in navigating the patient portals so if you are having trouble call tech support.
  • Be prepared for your doctor appointments. Just as you prepare for any appointment you go to, you should prepare for your doctor’s appointment. Doing so allows you to get the most out of your appointment. Make a list of questions or things you want to share with your doctor. If you are not sure about something you are doing, you can ask the nurses or the medical assistant who work with your doctor. Today, most doctors have several people who work with them to help patients with the challenges they face. This could be a nurse, a case manager or a patient advocate. These professionals have more time to spend with you so take advantage of them so you better understand the plan of care.
  • Ask a family member or friend to accompany you to your appointment. Most people go to their doctor’s appointments themselves and do fine. But if you are getting news on a new diagnosis, or have a health challenge, you might want to have a second set of ears to help you remember what your doctor said. Most doctors are used to having patients brings someone with them to appointments so don’t be afraid. If you are comfortable, you and the person who accompanies you will see the doctor together to discuss your situation and ask any questions that may come up. Many times you will forget to ask something and the person with you can remind you. The person who is with you should take notes so, after the appointment, you can discuss the appointment and review what was said and what you need to do. Notes from the meeting can go into your binder so you can refer to as needed.
  • Follow-up on tests that you have done. Make sure you call the physician who ordered the test to check the results. Many doctors have their office staff call you with the results, but sometimes they forgot to call you with the results. Don’t assume no news is good news. If you don’t have your results in a few days after the test, call the office to find out the results. Many times you will be asked to come in for the results.
  • Follow directions, but if something is not going as expected, call your doctor. When you see a doctor, a plan of care will be developed. You should be part of developing this plan to make sure you agree with it. Being part of plan development allows you to have a part in the process and helps to ensure your commitment to the plan. If the plan of care you and your health care team develop is not meeting your needs, make sure you let the doctor know. Sometimes the original plan might not work and it has to be modified. Your doctor will not know this unless you or a family member call the doctor to let them know. Don’t wait till your next appointment if you notice something is not right or the plan is not working as expected

I hope these points help you to realize that you are the most important member of YOUR healthcare team. Being actively involved will help you regain control of your life and ensure you are getting treatment that meets your needs.


I wanted to share some of the past issues of Nurse Advocate that have touched on many of the points discussed in this post. These articles share my personal experiences as I traveled through my journey. The articles show how I have learned how to manage the challenges I encountered.
·       Taking Charge of Your Health and Healthcare. To read this post, click here.
·       Everyone needs an advocate when they are thrust into the complex world of healthcare. To read this post, click here
·       Seven Steps for Healing, To read this post, click here
·       The Patient as the Center of the Healthcare Team. To read this post, click here


Thanks for reading this issue of Nurse Advocate. Take care of yourself!


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