I painted a pretty bleak picture last week about how convoluted medical billing is and why most people are confused by the system. But, here ten ways you can take charge and get the most for your money when you visit the doctor.
10 Ways to Optimize Your Doctor's Visit (And Your Wallet)
1. Know Your Health Plan
I know, I know, those HR emails are usually snore inducing and open enrollment time is usually a mad dash to get the boxes checked. But, pay attention to what you’re signing up for. Take note of the deductible for your plan and whether your employer chips in. High deductible plans can be alluring because of their low cost and the option to enroll in a Health Savings Account (HSA). But, if you sign up for one of those, make sure you have the cash to spend the deductible during the year.
2. Know Your Health History
We are generally the worst historians about our own health history. After all, if we have gotten over our illness, we are likely to block it out of our mind and move on. But, our history can be key to solving the problems of the future. So, having our health history written down and with us is the best way to make sure our doctor is privy to all of our pertinent history. But, please don’t write a book about it. Much like a resume, if it’s longer than a page or two, it’s too long. So make a succinct, one page summary: a Health History Cheat Sheet. Keep it on you at all times. Download a free worksheet here.
Here are the major things you need to include:
Past Medical History: This includes all your past diagnoses, even if they are no longer bothering you. Yes, even if your blood pressure is great now with anti-hypertensive medications, you have a diagnosis of hypertension. So include things like diabetes, depression, breast cancer, etc.
Past Surgical History: Obviously, these are all the surgeries you’ve ever had. Bonus points if you have the year they were performed and the name of the doctor that performed the surgery.
Allergies: List all the meds you are allergic to and what reaction you had to them.
Current Medications: All meds that you are taking with doses and how many times you take them. Include over the counter supplements and herbals.
Pertinent Family History: Does a certain kind of cancer run in your family? Write it down here. List all major hereditary diagnoses in your immediate blood relations and who had them.
Code Status: DNR, Full Code, etc
Doctors involved in your care: List your primary and all your specialists.
Speaking of lists, make a list of what you want to discuss with the doctor before you go. That way you are less likely to forget something important.
3. Take Your Medications With You
No matter how hard you try to be organized, you may miss a key medication like a recent antibiotic or an over the counter supplement. So, just to be safe, take all your pill bottles with you when you go to the doctor. Everyone will love you for being proactive about your health and minimizing the dangerous guessing game of fill in the blank medicine.
4. Don't Assume EMR's Communicate
Perhaps I should have put this first. Many patients are surprised to hear that their records from the urgent care visit at a different institution down the street isn’t automatically in “their chart.” Even though medicine is now mostly electronic and your doctor spends most of her time typing while she is with you, all that information still doesn’t get shared very easily between facilities and specialists. Part of this is due to the HIPAA (Health Insurance Portability and Accountability Act) laws that require your signature and consent for records to be shared. The other part is that healthcare is still capitalistic and there are many EMR (Electronic Medical Record) companies that compete for the market share. So, different companies buy different EMR’s… that don’t communicate.
So, if you go to an urgent care, ask for a copy of your doctor’s note and take it to your primary care physician (PCP). If you go to the PCP, ask for a copy of their note and take it to your specialists. Keep a running chart of your own health history in a binder that you can access and transport. This is especially important for retirees travelling for an extended amount of time (I’m talking to you, snowbirds). If you have your previous imaging and labs on you, there is a smaller chance that redundant testing will be ordered every time you go to a new doctor at a different facility.
5. Know Where To Go
Speaking of urgent cares, PCP’s, and all, let’s go over which sites to go to when and what to expect.
Primary Care Physician: In the old days, your primary was you go to for all things. Unfortunately, the system is so overstretched now that access to your primary is a big problem. But, if you are mild to moderately sick, your PCP should be your first call. Your PCP has a long term relationship with you and should know you better than anyone. If nothing else, he will know where to guide you.
Urgent Care: Urgent cares are generally good for acute, less serious problems that need a quick, short term prescription, like antibiotics or steroids. They may be able to do simple procedures like an I&D or imaging like a chest x-ray. Obvious to their name, urgent cares are not meant for managing long term chronic conditions like diabetes and hypertension. They are also not meant to provide you preventative care.
Emergency Room: ER’s are for when you think you have an immediately life threatening condition like a heart attack, stroke, or appendicitis. ER’s are not for routine refills or screenings. ER’s are well equipped with imaging and specialist support, should you require any.
Speaking of knowing where to go, who you see is also important. There are MD’s, DO’s, NP’s, PA’s, etc. Each have different skill sets and training requirements. MD’s (Medical Doctors) and DO’s (Doctor’s of Osteopathy) are the traditional “doctors.” They go to medical school for 4 years, and do an intensively supervised 3+ year residency, followed by optional 3+ year fellowships for specialization. Doctors have a minimum of 18,000 hours of supervised clinical training. NP’s (Nurse Practitioners) have a minimum of 500 hours of supervised clinical training, but may have previous bedside nursing experience. Many NP’s have the ability to practice independently of a doctor’s supervision, depending on the state. PA’s (Physician Assistants) have a minimum of 2000 hours of clinical training and as current law stands, must be supervised by a physician. Billing rates vary for these different professionals, based on differences in training.
All of these professionals increase access to care and are valued parts of the healthcare team. You certainly don’t need a doctor for every single condition. But, knowing the training differences will help you make an educated opinion about the level of expertise your condition requires. If you know you want to see a particular professional, make sure you ask when you make your appointment and confirm the credentials of the person who walks in to see you.
6. Utilize Your Yearly Physical
Do you take your car in for an oil change and preventative check up? Most people do. The yearly physical is the same thing for your body. It is meant to prevent future problems and catch silent killers like hypertension before they cause irreversible damage. And, the good news is that most preventative tests and screenings are covered by most insurances. (The caveat here is that Medicare only covers an Annual Wellness Visit that is more a question and answer session, rather than a physical exam.) In any case, both are meant to save you money and headache in the end, so utilize them.
But, imagine you take your car in for an oil change and you have a broken tail light that needs fixing. If you asked the mechanic to take care of the tail light while you’re in for the oil change, would you expect to get the taillight fixed for no charge? Of course not. Similarly, if you have a new complaint that needs a workup and treatment at a physical, your doctor may ask you to reschedule for an office visit. If time permits, he may take care of it, but you may get charged additionally for an office visit. So be prepared for that.
7. Utilize Incentives By Your Health Insurance
It is in your interest and in the insurance company’s interest to keep you healthy. Most insurances offer some sort of discount or point system for exercising and staying healthy. Some may even cover the cost of your gym membership. Look into these and utilize them. Why not?
8. Price Shop
If you know you’ll need a certain service in the future, like hospitalization for a childbirth or an outpatient surgery, there are resources out there that will help you choose a doctor that will do it for best price. These are Healthcare Blue Book, FAIR Health Consumer, and New Choice Health. See the New York Amercian College of Physician’s Price Transparency information here. Also, utilize sites like GoodRx and SingleCare to find the best prices for your prescriptions.
9. Keep A Well Funded Emergency Fund
Health expenses are a fact of life. But, don’t let health emergencies become financial emergencies, too. Keep a well funded emergency fund so your bills don’t make you sicker.
10. Be Nice
Healthcare workers are generally giving individuals that are there to help people. But, they see a lot of abuse too. So, be nice to them, and they will move heaven and earth to help you.
I hope these tips help you make the most out of your doctors’ appointments.
Stay Frugal!
Dr. D
Standard Disclaimer: Not meant as individualized financial or medical advice. Views are my own. Photos from Unsplash.com