Being Your Own Health Advocate
Sometimes You Have to Be Demanding
Working in healthcare I see so many patients and families who are completely clueless when it comes to their health and the care they receive from doctors, nurses, and other health professionals. So many patients just take the information they are given as the gospel and never take steps to take control of their healthcare.
In the past year I have quickly learned that sometimes you have to fight for yourself and those you love. Within the past year both of my parent’s were diagnosed with cancer and both underwent surgery to remove the cancerous masses (kidney and prostate). Going into this situation I knew we needed to be prepared.
How many times have you been to a doctor’s appointment and you had so many questions that you wanted to ask the doctor, yet once you were actually in the room with them you forgot half of what you wanted to talk to them about? I encouraged my parents to use an app on their phones, such as Google Keep or Evernote, to make notes of questions that they wanted to ask the doctors.
We also did a lot of research on the various treatments available for each of their situations. Researching these topics is so easy today thanks to the internet. However, I do caution you that you can’t always believe everything that you read online. Do your research with reputable websites such as WebMD, American Cancer Society and the Mayo Clinic.
Understand How Your Insurance Works
I work with insurance companies on a daily basis and I see so many patients who have no idea what a copay is or coinsurance or deductible. Does your insurance company require prior authorizations? Find out the timeline for how long it takes to approve a test or procedure. Does your insurance company pay a certain percentage of your bill and then you are responsible for the rest? Have you met your deductible? Will you have to pay your deductible prior to a test or procedure? All of these are important questions that you need to know in order to take control of your healthcare.
Many insurance companies have a website where you can find the answers to a lot of your questions. My insurance company even has a cost estimator on their site. I can research a procedure and find out the cost and hospitals or clinics within a certain range of miles from my home.
Sometimes You Have To Be Demanding
I recently had to be very demanding with a doctor’s office where I am a patient. I felt like I had to turn on the “bitch mode” if you know what I mean. Over a month ago I went to see a different doctor for a second opinion in regards to my foot pain and diagnosis of plantar fasciitis. Getting a second opinion is so important. I had been going to another podiatrist for over a year and was being treated for plantar fasciitis but it just was not getting any better, actually was getting worse.
After seeing the second doctor he wanted to do an MRI, which requires the doctor’s office to do a prior authorization with my insurance company. Four weeks had went by and I had not heard anything from the doctor’s office. Over the last couple of weeks I called the doctor’s office to try and speak to the staff who submit the authorizations. Each time I was sent to a voicemail box and each time I left a message requesting a callback. No response.
Finally yesterday I had had enough. Like I said before it was time to turn on the bitch mode (sorry about the language). After calling and being sent to the same voicemail box again yesterday I called my insurance company. They informed me that they had not even received a request from the doctor. So, I called my doctor’s office back and asked to speak to the office manager. I informed her about my situation. She was very nice and apologized repeatedly and assured me that I would receive a call back from her office within an hour.
Sure enough, within an hour one of the staff members called me. She informed me that my insurance company had denied the request for an MRI. The solution to that would be for the doctor to call the insurance company himself and do what they call a peer to peer review to try and get them to approve the MRI. The staff from the doctor’s office advised me that it would be at least a couple of weeks before the doctor could call because he was out of town. By this time my blood was boiling! I nicely, but very firmly, informed her that that timeline was not acceptable. I am in pain on a daily basis to the point that I can not walk sometimes. I “strongly” suggested that she get one of the numerous other doctors in the clinic to call and do the peer to peer review and also advised her that I would expect a call back by the end of the day to let me know the status of the request. I could tell she was very shocked that someone was standing up to her.
Sometimes it pays off to be demanding and advocate for yourself. By the end of the day I had an MRI scheduled for next week and a follow up appointment with the doctor. Had I just set back and let the doctor’s office work on their own timeline I would probably still be waiting for an MRI two months from now.
If you or your loved ones are dealing with health related issues, take the steps needed to be your own healthcare advocate.
* Ask Questions
* Be Prepared
* Understand How Your Insurance Works
* Stand Up for Yourself