Save Money and Stay Healthy With These Simple Tips

By Britt Johnsen and Emily Hulstein

If you want to stay healthy, preventive care is a must.

Fortunately, many preventive care services are free under the ACA. When the new healthcare rules passed, insurance companies became required to provide full coverage for certain services.

January - Preventive Care

These services have to be in-network, and they include things like regular checkups, screenings and immunizations. These services have a number of benefits:

  • Helps detect the possibility of serious conditions as soon as possible so that they don’t have a chance to progress into later stages.
  • Helps doctors to evaluate your health and make sure you are getting the right screenings based on your age, gender and family history.
  • Helps you stay healthy and keep money in your pocket.

The difference between a preventive visit and an office visit are that preventive services help you check for issues while you’re healthy. An office visit, however, treats a specific problem or medical condition.

How do you get the most out of these services? Here are some important tips:

Discussing or receiving care for an existing symptom or problem while at a preventive visit may not qualify as preventive care, and thus may be subject to deductibles, co-pays or co-insurance. Issues related to coverage of preventive care do occur, and quite frequently. It’s one of the biggest problems related to this change under the ACA. If you receive a bill after receiving preventive services, contact your provider. Many billing issues or errors, related to preventive services, are cause by procedure coding problems. Some preventive services may require more than one billing code to be used, and your insurance provider may not consider a code qualify as preventive. It may be possible for your provider to re-submit your bill under a different code, or talk with your insurance carrier on the discrepancy.

Receiving tests or services considered “preventive” while at a visit will not be considered preventive if you get them as part of a visit to:

  • Diagnose a new condition
  • Monitor an existing condition
  • Treat an illness or injury

If your doctor recommends additional tests, you will want to clarify whether or not these are covered under your plan. Always make sure you know what tests you are receiving and whether or not they are considered preventive – and then covered.

 

How to learn more:

Check out the ACA preventive care benefit guides for adults here; for women here; and for children, here.

Trig also has a number of tools available to assist you with your preventive care. Check them out here.

Do you have any questions? Feel free to contact your Health Risk Consultant, who can help you anytime with questions about your coverage, about preventive care services, and more.

How to Prepare for Healthcare Costs

By Britt Johnsen and Emily Hulstein

We at Trig know healthcare can be super expensive. That’s one of the reasons we created Trig in the first place; we want healthcare to be less overwhelming and more manageable for you.

With the right information, that’s possible.

So today’s blog post explores several ways you can prepare for healthcare costs. Sure, surprises come up, but you can keep those surprises tame with these tactics.

money pills

Budget like a pro. When you sit down to budget, be sure to track the last year’s medical expenses. This will give you a better idea of what you could face in the coming year. You can use the number as a starting point to for how much you should budget in medical expenses for this year.

Don’t know what your past expenses look like but need a place to start? Think realistically about what your annual healthcare costs may look like. You will want to be sure to include recurring costs like your insurance premiums, co pays and prescriptions, and then budget those into your expenses accordingly. You will also want to think carefully about any planned, or potential, procedures you or a family member could need in the coming year. This will help to make sure you don’t get backed into a corner, surrounded by medical expenses that you can’t afford.

Look around for a budgeting tool that works best for you. You can find various tools online to help you with this process. Some are even free. You can also sit down with an accountant to receive expert advice.

Expect the unexpected. One way to do this is to create an emergency fund. You can’t predict the future, so help yourself prepare by putting money aside. This is especially important if you’re on a high-deductible health plan. You don’t want to find yourself unable to pay for your medical expenses and piling up debt, so use your deductible and out-of-pocket maximum as a starting point of how much you should save. This emergency fund will also be beneficial should you lose your job; it will help you from immediately dipping into savings.

Save like a pro. Both health savings accounts (HSAs) and flexible spending accounts (FSAs) are great for setting aside money for healthcare expenses.

HSA: These are pre-tax accounts that can be used towards qualified medical expenses. They are intended to help you prepare for and pay out-of-pocket healthcare costs. Typically, these plans are paired with a high deductible insurance plan. One advantage of an HSA is that the money in the account rolls over each year, so it accumulates over time.

So how much should you save? As much as you can! Any excess not used for medical expenses can be used as an extra retirement fund that you can use for any purpose — not just medical expenses.

FSA: These operate like HSAs – but the difference is that the money in these accounts must be used within the year or it goes away. When it comes to an FSA, it is better to over-estimate than under-estimate your costs, since they disappear at the end of the year. Therefore, there is no reason to wait on pulling money from your FSA. If an expense occurs, don’t hesitate to pay out of this account.

Get great coverage. Get a health insurance policy that fits your needs. Find a policy that covers the areas where you will need coverage. Insurance plans are typically not one-size-fits-all, so take the time to look around and find a plan that has coverage where you need it most.

For example, if you’re pregnant or plan to get pregnant, you’ll want a policy that has good pre-natal, maternity and newborn care coverage. Or if you know you need or may need multiple medications, get a policy with good prescription drug coverage.

Also, be sure to pay attention to a plan’s annual out-of-pocket maximum. This is the most you can be required to pay for healthcare in a year. When looking at plans, you will want to make sure that this is a number you are comfortable with.

Get even more coverage. Supplemental insurance plans are policies that help you pay for things that your regular health insurance plan doesn’t cover. The benefits are paid directly to you, not the medical provider. That means you can use the benefits to pay for out-of-pocket costs, supplement lost wages, or pay for some of the other unexpected expenses due to illness or injury.

Depending on your situation, buying supplemental insurance may be a good choice to ensure additional coverage at the cost of a monthly premium.

Be proactive with preventive medicine. Although some things are out of our control, there are certain preventive measures we can take to help protect ourselves. The great news is that many of these things are fully covered by your insurance! Don’t skip your annual check-up, for example. These are completely covered and can help detect problems before they become bigger issues. It’s important for you to remember that most of these preventive services are only covered once a year.

Trig offers tools to show you what preventive care is covered under the Affordable Care Act. We also have a great tool for you to track your doctor’s visits, and any notes from those appointments. Check them out here.

Now it’s your turn. How do you prepare for healthcare costs? Do you have veteran advice, or questions?

Let us know in the comments.

If you found this article helpful, please share with friends and family. The smarter we can all be with our money, the better off we will all be.

How to Fund Long-Term Care

Do you think you or your loved one may need long-term care – soon or someday?

Long-term care covers a wide range of services that meet your personal care needs, including both medical and non-medical support. While it’s common for people to need this type of care as they get older, some need this kind of care much earlier in life because of an injury, chronic illness or disability.

Nurse and elderly man spending time together

But finding that support isn’t always easy. It can be expensive, not to mention confusing to navigate.

Here, we break down for you how you can find long-term care coverage. Let us know if you have any questions; your Health Risk Consultant (who is available to all Trig members) can always help.

The truth is that long-term care is expensive. According to 2010 statistics from Longtermcare.gov, it costs $205 per day or $6,235 per month for a semi-private room in a nursing home; $3,293 for care in an assisted living facility; and $21 an hour for a home health aide.

However, there are several options for getting coverage to help you out:

Medicare

Medicare only covers medically necessary care and focuses on acute care (such as doctor visits, drugs and hospital stays). Medicare coverage also focuses on short-term services for conditions that are expected to improve (such as physical therapy to help regain function after a fall).

Here’s who’s eligible: People 65 years and older, people under 65 with certain disabilities, and people of all ages with end-stage renal disease.

For more information on Medicare coverage, click here.

Medicaid

Medicaid is key for people who make a low income because it pays for some or all of their healthcare bills.

Coverage varies from state-to-state, and all participants must meet income and asset requirements. Each state administers Medicaid differently, but typically assets have a $2,000 limit per person.

If a person meets Medicaid requirements, it covers nursing home services for all eligible people age 21 and older. It also covers home and community-based services for people who would need to be in a nursing home if they did not receive home care services. In most states, it will cover services that allow you to stay in your home.

Health insurance

If your insurance company covers long-term care situations, typically it’s for skilled, short-term, medically necessary care.  In general, health insurance covers only very limited and specific types of long-term care and disability policies don’t cover any at all.

Most forms of insurance follow the same general rules as Medicare. Check with your insurance company to see what they offer.

Do you need to shop for long-term care insurance? One of the best times to buy long-term care insurance can be in your mid-50’s. If you need insurance now or will soon, here’s a great resource to help you find the best coverage.

You can also search this state-by-state resource to see what insurance companies offer long-term care coverage: www.usa.gov/directory/stateconsumer/index.shtml

Also, many private and public employers, including the federal government and a growing number of state governments, offer group long-term care programs as a voluntary benefit. Typically employers don’t contribute to the premium cost, but they can help negotiate a better rate.

If you’re employed, it might be easier to qualify for long-term care insurance through them rather than buying a policy on your own.

If you are already in poor health or are receiving long-term care, you may not qualify for long-term care insurance. You may be able to buy limited coverage or coverage at a higher “non-standard” rate.

Other Funding Options

If you have enough income and savings, you will need to pay for long-term care services on your own, from your incomes, savings and possibly the equity in your home. To pay privately, check out these options: http://longtermcare.gov/costs-how-to-pay/paying-privately/

If you don’t qualify for long-term care insurance, you may choose to enter into an annuity contract with an insurance company to help pay for long-term care services. In exchange for a single payment (or a series of payments), the insurance company will send you an annuity, which is a series of regular payments over a specified and period of time.

There’s also this option for state-based programs:  http://longtermcare.gov/medicare-medicaid-more/state-based-programs/

We hope this helps you in your journey to fund long-term care. If you have any questions, don’t hesitate to contact us at info@trigls.com or 855-633-TRIG (8744). You can also contact your Health Risk Consultant.

Save Money With These Top Tips

Here’s the deal: The people who bill you for your medical services sometimes make mistakes.

Those mistakes can cost you money.

A good way to make sure you’re paying for the medical services you got is to understand your Explanation of Benefits, or EOB. An EOB looks like a medical bill but is not, and it gives you details on how your insurance company processed medical insurance claims. The EOB tells you what portion of the claim was covered and paid to the provider by your plan. It will also tell you how much, if any, of the bill you are responsible for.

Reading your EOB is not exciting, but it could save you real cash.

Photo for Oct. Blog Post

You need to read your EOB. Yes, it might take extra time, and it may not be lively reading. But it’s important.

Avoid overpaying for medical care by understanding your EOB.

It’s important to understand your EOB because there are a couple of different errors that can happen. One is an error from a provider. When you get an EOB, you should look it over and compare it to your medical bills to ensure that you are paying the medical provider the right amount. If you find an error on a bill, you should call your provider and explain that your EOB shows a billing error.

The second is an error from an insurance carrier. Similar to billing errors, insurance carriers can make coding errors when processing claims. If you do not understand something on your EOB, or you think your insurance policy should cover a service that was not paid, call your carrier for an explanation or to have the benefit reviewed. In some cases, your EOB may list a Reason Code. A Reason Code will give you the explanation to why a service was not covered, but you may need to contact your carrier to find out what explanation this code responds to.

If you feel confused, this might help.

You might be wondering what you’ll find on an EOB. Here’s an explanation:

Personal Information: You will find information like your name, account number, and more. The most important number for you to note is your Claim Number (or Invoice Number). If you have questions or notice any errors, you will need to reference this number when talking with your carrier.

Sample EOB - Patient Information

Provider Information: You will notice the name of the provider of your services. This will be useful because it, along with the date, will tell you which of your doctors bills to associate this EOB with. It is possible that you could receive more than one EOB for each of your medical bills. If this happens, make sure you carefully compare to ensure you haven’t been charged for the same service twice.

Sample EOB - Provider Information

Services Provided: The list of services, CPT codes, amount billed and amount approved will all be listed.  You will be able to find how much was billed, how much the insurer paid, and how much of your deductible was applied.

Sample EOB - Services Provided

Don’t let strange terminology derail your budget.

The list of services provided may look unfamiliar and confusing. If you find this to be an issue, you can use a medical dictionary or do a CPT code search to gain a better understanding of what you are looking at. A CPT Code (Current Procedural Terminology) is a five-digit code assigned to every service a healthcare professional may provide to a patient. Insurers use these codes to determine the amount of coverage they will give to the provider. Everyone uses the same codes for the same services to ensure consistency. When you compare your list of services on your medical bill to your EOB, the CPT codes should match identically.

Doing all of this will help you pay only for the services you actually used.

You will also find a series of numbers broken down into different categories.

  • Charges: Amount the provider charged for each of the services you received
  • Allowed Amount (Adjustments): The rate negotiated by your insurance carrier (or possibly you) for a particular service. NOTE: In most cases you will not be responsible for the difference in prices between this and charges.
  • Amount Owed (Patient Due): The remaining amount of money that you must pay for the services received. NOTE: In some cases, you may see additional charges on an EOB for existing services that need to be paid. These may not be broken down by individual services, but rather a date and an amount that are carried over and added to your new EOB.

Do you have questions? Let us know by calling 855-633-TRIG (8744) or e-mailing info@trigls.com.

How to Save Money on Prescriptions

Medication can be very expensive, and a burden on some budgets. But it doesn’t have to. Here are some steps you can take to find the medication you need for the best cost:

money pills

Get what you need – and get it cheaper. Learn what medication it is that you need, and then contact your insurance carrier to find out if a generic version is available. Generic drugs are generally the same as their brand-name counter-parts, but are typically less expensive. You can find out about generic medications by asking your provider or calling you carrier’s customer service line.

Try a sample. You can ask for free medication samples, if they are available. Your healthcare provider will let you know if free samples will work for your situation but don’t hesitate to ask since your provider may not think to offer them. Also, keep in mind that samples are usually for expensive name-brand medications, so if you need to continue taking the medication after your sample runs out, you may end up paying more in the long run. Samples are good options for short-term medication needs.

Learn about your coverage for both generic and brand-name drugs. A formulary is a list of medications, generic and brand-name, that your health insurance plan will cover. Medications not on your formulary will require you to pay out-of-pocket. To find out what medications are on your formulary, you can look at your plan documents, or you can contact you insurance company to request a copy. You may be able to find this information on your carrier’s site, as well.

Get permission. Your health insurance carrier may require prior authorization from your doctor before your pharmacy can fill prescriptions. This is a review and approval process for medications. Some carriers require this to get more information before deciding whether or not they will cover the cost of your prescription.

Shop around. If a drug is not on your formulary, or if it is only partially covered, you will want to shop around for the pharmacy with the lowest price. You can call pharmacies, do online research and compare pharmacy prices in your area. You can also see if you’re eligible for assistance programs; some pharmaceutical companies offer certain medications free of charge or for a lower co-pay. Be sure to ask your provider if you would be able to take advantage of these programs. Government and private programs that can help lower the price of your prescription. Check if you are eligible by going to www.benefitscheckup.org or www.rxassist.org.

Photo credit: Lisa Yarost

How to Choose a Champion

Everyone needs a champion, but when it comes to your health, it’s even more important. A Healthcare Champion, or caregiver, is someone you can trust to look after your best interests while you go through a medical treatment. This person is usually a loved one, such as a family member, spouse/partner or friend.

NCI image - May Blog Post

But not everyone would make a good champion. That’s why it’s crucial to choose the right champion; your Healthcare Champion should meet the following criteria:

*Dedicated to your well-being

*Willing to learn anything needed to help you

*Dependable

*Has time in their schedule (or can make time)

*Patient

*Persistent

*Organized

*Handles stress well

*Has access to a phone and a computer

Your Healthcare Champion doesn’t need to have special qualifications. He or she also doesn’t have to have extensive knowledge about your illness or the healthcare system. It’s important that they have the kindness, compassion and character to help you.

Trig has a special quiz designed to help you decide if the person you have in mind is the right person to be your Healthcare Champion. Click here to take the quiz.

If you’re interested in becoming a Healthcare Champion, click here to learn more. If you need a Healthcare Champion and want to search for one, check out Trig’s MedChamp service here.

Have any questions about this or other topics? Contact your Health Risk Consultant for personalized advice. Jeremy Vang is at jvang@trigls.com, and Emily Hulstein is at ehulstein@trigls.com.

Photo Credit:

National Cancer Institute (NCI)

How to Prepare for Emergencies

Red cross 1

You could save someone’s life – that of a stranger, a loved one, or even your own – with the right knowledge and resources.

Sometimes you’re faced with emergencies that require life-saving information. For example, CPR could save the life of someone who had gone into cardiac arrest. And knowing who to call, by having the phone number on hand, could also save precious and much-needed time when it’s urgent.

So how can you prepare for emergencies? We’ve put together a few steps and a couple of lists with key information. Here’s how you can be ready for any situation, and potentially save lives in the process:

Carry medical information. Keep this information at your fingertips to be prepared in case of an emergency:

  • Name
  • Birth date
  • Blood type
  • Organ donor information (if you are or are not one)
  • Advance directives and end-of-life wishes
  • At least two emergency contacts: name, phone number, relationship to you
  • Name and phone number of primary care physician
  • Name and phone number of pharmacy
  • List of major surgeries and their dates
  • List of major medical conditions
  • List of allergies and your reactions to them
  • List of current medications (include name, dosage, how often it is taken and reason for taking it)

Keep a well-stocked first aid kit. Be sure to keep a first aid kit around, and include these items in your kit:

  • Activated charcoal (this is an antidote to several poisons and functions as a detox for drug overdose)
  • Adhesive tape
  • Aloe Vera gel
  • Antibiotic ointment
  • Anti-diarrhea medication
  • Antihistamine
  • Antiseptic solution
  • Aspirin and non-aspiring pain killers
  • Band-aids
  • Calamine lotion
  • Cotton balls and Q-tips
  • Disposable gloves
  • Epinephrine pen
  • First aid manual
  • Gauze pads
  • Hand sanitizer
  • Hydrocortisone cream
  • Instant cold packs
  • Ipecac
  • Medicine measuring cup
  • Personal medications
  • Petroleum jelly
  • Roll of elastic bandage wrap
  • Safety pins
  • Saline solution
  • Scissors and tweezers
  • Thermometer

 

Learn CPR. This skill could save someone’s life. Learn CPR at Red Cross locations, community colleges, universities or your local city or community center. A simple search engine query, “Your city’s name” + “CPR classes” should do the trick.

 

Sources:

Build a kit: http://www.ready.gov/build-a-kit

Training and certification: http://www.redcross.org/take-a-class

Photo Credit:

Alexey Lisovoy, Dreamstime.com.

5 Steps to Choosing a Health Insurance Plan

blog image - juneYou are ultimately responsible for paying your healthcare bill after doctor visits or hospital stays. And ultimately, what makes your health insurance premium cost you less or more is the medical care you use and the amount of claims paid.

So, the health insurance plan you choose is very important. Here are five steps to help you choose the right health insurance plan for you.

Step 1: Consider Your Needs and Preferences

  • What to consider:
    • Do you need a single or family plan?
    • Do any of your family members want to purchase insurance on their own?
    • Do you or your family members have a chronic health condition such as diabetes or heart disease, or plan to have a baby? This could lead to an increased use of healthcare.

TIP: If your situation will require a lot of time spent in healthcare facilities or regular prescriptions, you will want to choose a plan that offers good coverage in these areas.

Step 2: Examine Provider Options

  • What to consider:
    • What providers are close to where you live or work?
    • What providers do you prefer?
    • Do any of your dependants have a primary care physician you would like to continue seeing?

TIP: If you or one of your dependants have a current physician they would like to continue seeing, you will want to choose a plan that covers that doctor.

Step 3: Look at Coverage Options

  • What to consider:
    • Can I get coverage through my employer?
    • Am I willing to pay out-of-pocket costs for premiums, co-pays, deductible, prescriptions and other service fees?

TIP: Consider what your biggest needs may be, as well as what you can afford. This will help you choose the best policy for your situation.

Step 4: Compare Plans

  • What to consider:
    • Does the plan fit my needs?
    • What does the plan cover for doctor’s visits, hospital stays, surgery, etc.?
    • How much coverage is provided?
    • Do I need the services provided?
    • Am I comfortable with these costs?
    • Does the plan cover my desired providers?

TIP: If you have multiple plans to consider, first rule out those that do not meet your needs, then compare your remaining options. The more frequently you believe a service will be used, the more important the coverage.

Step 5: Make a Decision

  • What to consider:
    • Ask yourself many of the questions you’ve already considered. This will ensure you’re going in the right direction in choosing a policy.
    • Are you comfortable with the plan you’re considering selecting?

TIP: Be sure that you’re satisfied with the plan you select. It’s important to be comfortable with your policy.

 

Photo Credit:

Anatoliy Babiychuk/Dreamstime Stock Photos

Leaving the Hospital or Clinic: A How-To Guide

When you leave a hospital or clinic after getting treated, it’s important to know the right steps to take. Ultimately, this will help you stay healthy, save money and reduce unnecessary visits later. Unfortunately, many people encounter problems after a stay in a hospital or clinic; about a third of patients say they have continuing issues afterward. So what should you do to prevent problems and ensure you take all the right steps as you leave? Trig Life Services has put together a step-by-step process for you:

NCI image - May Blog Post

1.)  Before you leave, be sure to get any necessary information for carrying out your treatment plan. Do this at least a day before you leave so that your family, doctor or the hospital can arrange monitoring services if you need them at home.

2.)  Ask about possible complications – and what to do if they arise. You should be sure you have a good understanding of what symptoms you could experience, possible signs of complications, as well as who to contact should something happens. You can ask these questions:

  • What are the potential side effects, physical problems or pain that can be expected?
  • What can I do to relieve this pain?
  • If problems arise, who should I contact?
  • How likely is my condition to flare up?
  • What is the expected recovery time?

3.)  Get a copy of your treatment plan (or discharge summary) and make sure you have a full understanding of your recovery instructions. Ask the following questions:

  • What should I do when I get home?
  • Do you have any care instructions?
  • What future tests, procedures and appointments are part of my treatment plan?
  • How long will my treatment plan continue?
  • Will there be changes in my treatment plan over time? If yes, what changes will occur?
  • Who can I talk to if I have questions about my treatment plan down the road?

4.)  Find out if you have any activity restrictions – if so, what they are, and how long they will last. You can ask these questions:

  • Can I shower?
  • Do I have any dietary restrictions?
  • Can I return to work? If not immediately, when?
  • If I need clearance to return to work, who do I need to contact?
  • What is considered “rest”? How long do I need to rest for?
  • Will I need anyone to help me or will I be able to manage the treatment plan on my own?

5.)  If you are prescribed medications, know what they are, what they do, as well as instructions on how and when to take them. IMPORTANT: if you are taking any other medications, make sure you discuss any possible issues between the medications you are taking and the new ones. Ask the following to ensure you have a good understanding of your medications:

  • What new medications have I been prescribed?
  • What instructions do you have regarding these medications?
  • Why am I prescribed these medications?
  • What side effects could I experience as a result of taking these medications?
  • Who should I contact if I am having problems with my presciptions?
  • Have my medications been sent to my pharmacy?

6.)  Learn about any follow-up appointments that may be necessary and schedule them. You can ask:

  • Is there a follow-up appointment? If yes, is the appointment with you or someone else?
  • How many follow-up appointments are needed and when? When should I schedule these?
  • What can I do to keep my treatment prices down?

7.)  Arrange for any at-home aide or assistance that may be necessary. This could include personal care, household care or emotional care. IMPORTANT: contact your insurance company to make sure these types of services will be covered before you use them.

8.)  Ask about anything that is unclear to you. Never leave if you feel unsure about anything.

9.)  Do not to leave the hospital or clinic without first going over the bill (this helps to decrease billing confusion later). Be sure to do the following:

  • Request an itemized list of services.
  • Request to have an accounting person review it with you so you can make sure it is accurate.
  • Take a copy with you so that you can compare it to the actual explanation you receive from your insurance company or bill you receive from the healthcare provider.
  • Ask the accounting office if the price you are being billed is the negotiated rate with your insurance company. Checking this can help ensure you don’t have to pay more than these rates.

10.) When you leave, don’t ignore your doctor’s instructions. Follow your treatment plan and instructions very carefully. Not taking prescribed medication, missing follow-up appointments, not taking care of incisions and not getting therapy are all potential setbacks to recovery.

Remembering the answers to all these questions can be difficult. Having a discharge checklist can help to ease the process. Below are links to two discharge tools that may be helpful for you.

http://www.triglifeservices.com/uploads/modules/Discharge%20Checklist%20Tool.pdf

http://www.npsf.org/wp-content/uploads/2011/10/Post-Discharge-Tool.pdf

For more information about preparing to leave the hospital or clinic, Trig members can watch or read Healthcare Navigation Module 9: While I am a Patient and Module 10: When My Treatment Ends

Sources:

http://www.consumerreports.org/cro/2012/10/your-hospital-survival-guide/index.htm

http://caregiver.org/hospital-discharge-planning-guide-families-and-caregivers

Photo Credit:

National Cancer Institute (NCI)

How to Find the Right Doctor

The majority of the content in this blog post is from Trig’s Healthcare Navigation Module 8: Selecting a Healthcare Professional.

couple with doctor

Finding the right doctor can be a difficult task. Not only do you want a provider who’s in your area, in your insurance network and in your price range, but you also want to feel comfortable with them and feel confident that they are meeting your needs and wishes. This is a tall order, but it can be done.

Many people don’t take the time to search for the right doctor – or don’t know how – and end up going to see whichever doctor is available. This isn’t a good plan, either, because you’ll want a doctor with whom you can develop a relationship and establish trust. Whether you’re seeking a general practitioner or a specialist, if you’re entrusting your health to this person, you should probably make sure they’re the right fit by doing your research and meeting with them ahead of time.

Here are some steps to follow to find the right doctor for you:

  1. Research your condition
  2. Search for doctors in your area and insurance network
  3. Research quality
  4. Set up an informational consultation
  5. Make a decision
  6. Ensure you are getting good quality care

Step 1: Research Your Condition

Before you even schedule an appointment, it’s a good idea to conduct some simple research on your own to learn more about your condition and symptoms using resources like WebMDthe Mayo Clinicthe National Cancer Institute and the National Institutes of Health. Doing your own research may help you understand and answer your doctor’s questions more completely when you go in. However, beware of diagnosing yourself based solely on your web research; visiting a healthcare professional is always the best way to receive an accurate diagnosis.

Step 2: Search for Doctors in Your Area and Insurance Network

Oftentimes, the best place to start your search is your insurance company’s website. Most insurance companies have online provider directories that allow you to search for in-network physicians or facilities by zip code, specialty, etc. Trig members can use our Provider Search for quick access to these directories.

Step 3: Research Quality

Once you have narrowed down your list of potential doctors, you should research each of them to find out the following information:

  • Certifications
  • Years practicing (experience)
  • Specialties
  • Reviews/ratings
  • Complaints from patients

Some of this information you can get from your insurance company’s directory, but some of it you may have to get elsewhere. You can contact your state’s Board of Medical Practice to find out if any complaints have been filed against a doctor. Certificationmatters.org has a search feature that allows you to find out if a doctor/specialist is certified by the American Board of Medical Specialties. And you can access reviews and/or ratings of healthcare professionals on the following sites:

Step 4: Set Up an Informational Consultation

After conducting your research, set up an informational consultation with a doctor (or doctors) you are interested in. You can do this by calling the the physician’s office and setting up the consultation over the phone. During your appointment, be sure to do the following:

  • Confirm that they are covered by your insurance.
  • Ask questions about their experience.
  • Assess your comfort level.
  • Ask how they expect your treatment plan to work (if applicable).
  • Ask if you can contact them after hours when needed.

You should also ask yourself the following questions after the appointment to determine whether or not the doctor is a good fit:

  • Do I trust this person? Do I feel respected and heard?
  • Does the doctor explain critical information clearly so that I understand it?
  • Are the facilities up to my standards, and are they located a convenient distance from my home?

Step 5: Make a Decision

Once you’ve gone through steps 1-4, it’s time to choose a doctor. Remember that ultimately you’ll want to select a doctor or specialist that you feel comfortable with. Trust your instincts when you make your decision.

Step 6: Ensure You are Getting Good Quality Care 

You want your healthcare providers to be skilled and knowledgeable, of course. But that’s not enough – they should also be good at communicating with you. Do they listen carefully and explain things in a way that you can understand? Do they take your values and preferences into account and involve you in making decisions that affect your health? Do they spend enough time with you and make you feel comfortable about asking questions?

If the answer to these questions is ‘no,’ perhaps you should reevaluate your decision. If the doctor you choose doesn’t turn out to be a good fit, don’t be afraid to change doctors. Your health matters too much for you to stay with a provider who isn’t meeting your needs.

For more information about finding the right doctor or specialist, Trig members can read or watch Healthcare Navigation Module 8: Selecting a Healthcare Professional. 

Additional Resources:

Image Credit: Rhoda Baer