Month: May 2018

Get Your Doctor Working as Your Partner

LearnToLead

Last Revised: 3/4/2020

How do you talk to your doctor? Does he or she do all the talking while you do all the listening? Are you afraid to ask questions? Do you leave the office feeling like you just sat through a foreign language class?

Practicing open communication with a doctor that you trust can help increase your confidence that you are making good choices and in achieving a positive outcome. The basics of open communication include understanding that your doctor may have limited time to speak with you.

Step 1: Prepare

You can prepare for any communication with your doctor or their practice by thinking about and writing down what’s important to you and all the questions you have before you call, email, or visit the office.

To get you started thinking about what matters to you, here’s a list of common questions to ask if you’re not feeling well;

  • What do think might be wrong with me? How do you know?
  • What are the common causes of this problem?
  • Will I need any tests?
  • Which tests might I need?
  • What does each test involve?
  • How do I prepare for each test?
  • Will my insurance pay for the tests?
  • What are my treatment choices?
  • What are the benefits and risks of each treatment?
  • What are the side effects?
  • How are the likely outcomes of each treatment?
  • Which treatment is the most common for my condition?
  • What would be the “next steps” if treatment fails?
  • What kind of medication(s) must I take? For how long?
  • What does the drug do? Will there be any side effects?
  • What should I do if I have side effects?
  • Can I take a generic version of the drug?
  • Will the medicine interact with any I am already taking?
  • Should I avoid any kind of food or activity while taking this medicine?
  • Will I need to see a specialist?
  • Should I get a second opinion?
  • Do I need a follow-up visit?

Additional preparation includes:

  • Prioritize what’s important to you. Your doctor may not have time to answer all of your questions.
  • Write down a list of your symptoms, and share them or bring the list to your office visit.
  • Write down all the medicines you take. Write down the doses and how often you take them. Include vitamins and other supplements.
  • If you’re going for an office visit, arrive early enough to fill out forms, or fill them out in advance.
  • Always have your health insurance information available.
  • As best you can, have access to your medical records, bring them with you to an office visit, or have them sent in advance if you’re seeing the doctor for the first time.

Speak Up 

Don’t be put off by big words, or a doctor’s impatient manner. If you don’t understand what the doctor or their staff is telling you ask them to explain it again using different words, or a drawing if needed. Don’t leave or end the conversation without understanding everything you were told. If there are issues you want to discuss that weren’t mentioned, bring them up yourself. Doctors and healthcare professionals often are so focused on making sick people better or are so rushed that they may forget to talk about important health matters like diet, weight, exercise, stress, sleep, tobacco use, alcohol use, sexual practices, vaccines, etc. Ask what tests you might need for your age, such as a mammogram or colonoscopy, and ask your doctor about getting them. Don’t be embarrassed or ashamed to bring up sensitive topics.

Don’t Withhold Information

Speaking up also means telling your doctor everything you know about your body and health, including all your symptoms and problems. The more information you share the better your doctor will be able to figure out what’s wrong and how to treat you. Don’t make the doctor guess. Be sure to mention any and all medicines, vitamins, and herbs you are taking, and anyone else you are seeing about your health; both physical and mental.

Bring Someone with You

Sometimes, people like to bring a friend or family member to a doctor appointment for moral support. A companion might also help you relax, remind you of questions you forgot to ask, and help you remember what the doctor said. If you need personal time with the doctor, the person can sit in the waiting room. Having someone join you is especially helpful if you feel too ill to get around easily on your own.

Follow Up with Questions

If you feel nervous, rushed, or just plain overwhelmed you might forget to ask a question, even if you wrote it down. If this happens or if you think of a new question, call the office right away. Be patient but firm if you want to speak directly with the doctor. Although they may not be able to take your call at that moment certainly they will get back with you. If the doctor wants you to come back for a follow up visit be sure to set and keep the appointment

Building a successful partnership with your doctor takes time and effort. It’s not uncommon to have a frustrating doctor visit now and then. But overall, your relationship with your doctor should be positive and comfortable. You should have confidence and trust in his or her medical ability and judgment.

Tip: Let your doctor know when there’s a problem. If you can’t resolve things together, you might need to entrust your care to someone else.

Talking about Your Health

Talking about your health means sharing information about how you feel physically, emotionally, and mentally. Your doctor may ask when your symptoms started, what time of day they happen, how long they last, how often they occur, if they seem to be getting worse or better, and if they keep you from going out or doing your usual activities. Knowing how to describe your symptoms and bringing up other concerns will help you become a partner in your health care.

A symptom is evidence of a disease or disorder in your body. Examples of symptoms include pain, fever, a lump or bump, unexplained weight loss or gain, having a hard time sleeping, or anything that seems different that what you know as normal. Be clear and concise when describing your symptoms. Your description helps your doctor identify the problem. A physical exam and medical tests provide valuable information, but it is your symptoms that point the doctor in the right direction.

Questions to ask yourself about your symptoms:

  • What exactly are my symptoms?
  • Are the symptoms constant? If not, when do I experience them?
  • Does anything I do make the symptoms better? Or worse?
  • Do the symptoms affect my daily activities? Which ones? How?
  • Are there ways to keep my condition from getting worse?
  • How will making a change in my habits help me?
  • Are there any risks in making this change?
  • Are there support groups or community services that might help me?

Tip: Take the time to make some notes about your symptoms before you call or visit the doctor.

Worrying about your symptoms is not a sign of weakness. Being honest about what you are experiencing doesn’t mean that you are complaining. The doctor needs to know how you feel.

Give information about your medications. It is possible for medicines to interact causing unpleasant and sometimes dangerous side effects. Your doctor needs to know about ALL of the medicines you take, including over-the-counter (nonprescription) drugs and herbal remedies or supplements. Bring everything with you to your appointment if you have not written it down, or can access the information electronically. Do not forget about eye drops, vitamins, and laxatives. Tell the doctor how often you take each. Describe any drug allergies or reactions you have had. Tell your doctor which medications work best for you, and be sure your doctor has the phone number of the pharmacy you use.

Research shows that doctors can be influenced by pharmaceutical company promotions. One of the most effective promotions seems to be free samples.  Eventually free samples run out and a prescription needs to be written. It is not uncommon for the doctor to simply write the prescription for the same drug even though the doctor may have actually considered a different drug. Direct-to-consumer advertising by the pharmaceutical companies tries to get the patient to ask the doctor about a drug.  No matter what tactics the pharmaceutical companies use the point to remember is that there are often lower cost alternatives that work just as well as the more expensive, heavily promoted brand name drugs.

You might want to ask your doctor to consider the cost and effectiveness when choosing a drug to prescribe. You can also ask both your doctor and pharmacist about the availability of a generic substitution for the drug prescribed. That said, there is nothing wrong with asking for a highly advertised drug. Just remember that there are often alternatives.

Don’t forget to tell the doctor about your lifestyle habits. To provide the best care your doctor needs to understand you as a person and know what your life is like. The doctor may ask about where you live, what you eat, how you sleep, what you do each day, what activities you enjoy, what your sex life is like, and if you smoke or drink. Be open and honest with your doctor. It will help him or her to understand your medical conditions fully and recommend the best treatment choices for you.

Voice other concerns. Your doctor may ask you how your life is going. This isn’t being impolite or nosy. Information about what’s happening in your life may be useful medically. Let the doctor know about any major changes or stresses in your life, such as a divorce, the death of a loved one, or the loss of a job. You don’t have to go into detail. You may want to say something like “it might be helpful for you to know that my sister passed away since my last visit with you,” or “I recently had to sell my home and move in with my daughter.”

Tips for Making Good Use of Your Time 

  • Be honest. It is tempting to say what you think the doctor wants to hear. For example, saying that you smoke less or eat a more balanced diet than you really do. While this is natural, it’s not in your best interest. Your doctor can suggest the best treatment only if you say what is really going on. For instance, you might say: “I have been trying to exercise more, but I it is not working out as well as I had hoped.”
  • Decide what questions are most important. Pick several questions or concerns that you most want to talk about with the doctor. Tell your doctor what they are at the beginning of the appointment, and then discuss them each in turn. If you have time, you can then go on to other questions.
  • Stay focused. Although your doctor might like to talk with you at length, each patient is given a limited amount of time. Make the best use of your time by keeping the conversation focused on your questions.
  • Ask your doctor about prevention, and if there are ways to prevent conditions you are likely to encounter based on your family and personal history.

Share your point of view about the visit. Tell the doctor if you feel rushed, worried, or uncomfortable. If necessary, you can offer to return for a second visit to discuss your concerns. Try to voice your feelings in a positive way. For example, you could say something like “I know you have many patients to see, but I’m really worried about this. I’d feel much better if we could talk about it a little more.”

Remember, the doctor may not be able to answer all your questions. Even the best doctors may be unable to answer some questions. Most doctors will tell you when they don’t have answers, and they will help you find the information you need, or refer you to a specialist. If a doctor regularly brushes off your questions or symptoms as simply a part of aging or unimportant think about looking for another doctor.

Learn more about working with all of your clinicians; click here.

Winning Health Insurance Coverage Denials

Last Revised: 02/12/2019

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If you know someone who needs help with their health care finances, you can help them by sharing this link to free resources that are available for anyone.

How do you know if your claim for treatment was denied?

An Explanation of Benefits (EOB) which is sent to you by your insurance company is one of the only ways to determine what the insurance paid, and how much you may still owe. The EOB should also disclose if your claim has been denied.

If the insurance company portion of the payment shows $0, this can indicate that they denied your claim. The payment amount should be followed by a “Reason Code(s).” This code provides an explanation for the lack of payment. The insurance company may also send you a letter confirming the denied medical claim and detailing their reason(s) for denial.

Make sure to keep copies of all correspondence you receive from the insurance company, including denial letters, approval letters, your health history, medical files, doctor’s letters, etc. Always keep written records of all contacts and phone calls with the insurance company; including the name(s) of the people that you spoke too.

A Coverage Denial is not the Final Word

Many insurance companies deny claims simply because they know there is a good chance the policy holder will not fight back, or appeal.

If your insurance company denies coverage, follow the steps below:

Step 1: Check your plan to make sure the benefit you want is included. Make a note of the part of the policy that leads you to believe your claim should not have been denied.

Step 2: Collect and organize all information pertaining to the denied claim. Make sure you have the original bill with the date of service and the provider’s name, your EOB, and your insurance card before placing a call. If the insurance company sent you a letter, have that available as well.

Step 3: Call the number provided on the letter from your insurance company, or if you did not receive a letter the customer service number. There is a possibility the claim was denied because of missing information. Once the missing information is provided the claim will be re-processed, and hopefully you are done.

Step 4: Sometimes claims are denied because of improper coding. If that’s the case, ask your doctor to review the coding and re-submit a request with more specific medical justification for the procedure or medication, and you should be done.

Step 5: If your claim was not denied for missing information or improper coding, find out why it was denied, and how you can file an appeal.

Step 6: Ask the insurance provider’s representative for suggestions or guidelines for appealing a denial.

Step 7: If you would like an appeal form, ask them to send one via the mail or email.

Step 8: Make sure you have the address for the appropriate department to return the completed appeal documents.

Step 9: Always keep a record of the date, time, and the name of the insurance provider representative you talked with, along with a summary of the discussion. Keep this with copies of any documents you send to the insurance company.

Step 10: In appealing the denied claim, you should have the opportunity to review the information the insurance company used to make their decision.

Step 11: If necessary, get your doctor involved. To win an appeal you’ll likely have to to prove that the test or treatment is “medically necessary” and “scientifically proven.” Your doctor’s office should have staff that can help.

Step 12: Get help wording your appeals so that they mention medical problems, and do not include words that automatically trigger denials. Talk to the person who handles insurance claims at your doctor’s office. This person may be able to help you with the appeal process, and they may provide any documentation your insurance company requires.

Step 13: Remember each insurance company has its own appeal process. Before submitting your information, make sure you have completed and include the required paperwork. Once the documents are complete make a copy of everything for your reference.

Step 14: Continue to go through all levels of appeal.

Step 15: If your insurance company denies the claim again, in most cases you can contact them to request an external appeal. Usually, this appeal will be conducted by a medical professional or group of medical professionals not associated with the insurance company.

Step 16: Sometimes it takes the threat of a lawsuit to get your insurance company to move.

Send your correspondence to the insurance company via certified mail with return receipt. Be persistent. Remember that a denial is not necessarily the final word. Request in writing that your insurance company to reconsider their decision.

Contact your health insurance company within a reasonable amount of time if you don’t receive a written response that includes a justification. If you’re denied again and you believe that this is not consistent with your policy, contact your state insurance commission. That agency can mediate a dispute between you and your insurance company. If you win, you could save yourself hundreds or even thousands of dollars.

Medicare appeals need to follow a separate, federal appeals-review process.  There are detailed instructions for each level on the CMS website.

 

You Are Your Best Advocate

 LearnToLead

As a patient in the U.S. health care system you will face many obstacles to getting safe, quality, and affordable health care. To overcome them, you must advocate for yourself and lead your health care team. You’ll get a big assist from many primary and specialty care practices transitioning into medical homes and providing patient-centered care.

You are the core of your health. You make the most of the choices that impact your health. You certainly feel or suspect that something may be wrong long before anyone else. You decide when and how to engage with the health care system.

The crucial steps when advocating for yourself are: click