Category: Medical Care

*  Health Savings Account (HSA). Money set aside by you or your employer (on a tax-free basis) to pay for current and future medical expenses.

*  High-deductible Health Plan. A plan that has a high-cost yearly deductible that must be met before benefits are paid by the plan. It also includes a limit on annual out-of-pocket costs and a heath saving or health spending account. In-network preventive care services are free.

*  Indemnity Plan. This type of health plan is also called fee-for-service. You can use any medical provider. The provider bills for each service given. You and the insurance plan each pay part of the bill as stated by the plan.

*  Managed Care Plans. These kinds of plans provide services and handle payment for them. You have less paperwork with these plans compared to an indemnity plan. Managed care plans use certain doctors, hospitals, and health care providers. There are three basic types of managed care plans.

– Health Maintenance Organization (HMO). With this, you pick a primary doctor who manages all of the medical services you receive. HMOs offer a range of health benefits. This includes preventive care.

– Preferred Provider Organization (PPO). With this, a network of providers gives medical services at a discount to its members. With a PPO, you can choose one or more providers from a list of those who participate with the health plan.

– Point-of-Service (POS). With this, you have the option to go to providers outside of the plan’s network of providers. Some of the cost is still paid for by the plan.

*  Routine checkups, health screenings, and vaccines.

*  Preventive services, such as programs for weight control.

*  Maternity care. Care by specialists.

*  Hospital care. Emergency and urgent care.

*  Mental health care.

*  Substance abuse services.

*  Physical therapy and home health care.

*  Alternative health care.

*  Prescription drugs. Find out what the plan covers.

– Check out the plan’s formulary. This is a list of preferred generic and brand name drugs that the plan covers. In general, you have higher co-pays for brand name drugs than generic drugs. You pay even more for drugs not on the preferred list. Show your doctor your plan’s formulary when he or she prescribes medications for you.

– Find out what mail order pharmacy and local pharmacies the plan uses.

*  If you get health insurance through your work, find out what health plans are offered. Get information from the employee benefits office, the health plans’ Web sites, and/or from the insurance companies.

*  If you need to buy health insurance, find out about health plans from:

– The Health Insurance Marketplace atwww.healthcare.govor 800.318.2596. This resource allows individuals, families, and small businesses to learn about their health coverage options; compare health plans based on costs and benefits; choose a plan; and enroll in coverage. The Marketplace also gives information on programs that help people with low-to-moderate incomes and resources pay for coverage. Programs include Medicaid and the Children’s Health Insurance Program (CHIP).

– Your state’s health department.

– An insurance broker.

– Professional organizations and social or civic groups that offer health plans to members.

*  Know where to go for medical care.

*  Feel comfortable when you see or talk to health care providers.

– Check with the plan. You can find this out from the plan’s Web site. You can find this out from the customer service phone number on your health insurance card. If your health plan is from your workplace, you can ask the person at work who handles employee benefits.

– If you belong to a managed care plan, get a list of doctors who work with the plan. Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) are types of managed care plans.

– If you have Medicare, find out about doctors who accept this fromwww.medicare.govor call 1.800.MEDICARE (633.4227).

– If you have Medicaid, contactwww.cms.hhs.govor call or visit your local Social Security office.

– Discuss your health needs and ability to pay for premiums with an insurance broker. Find out about health insurance in your state fromwww.naic.org/state_web_map.htm.

– Look into group coverage. Find out if you can get health insurance from groups you belong to, such as the school or college you attend or groups, such as AARP.

*  If you cannot pay for health care, contact the Bureau of Primary Health Care atwww.ask.hsra.gov/pc. This site will help you find a clinic in your area that will provide medical care at a reduced cost or for free.

*  Know about “Insure Kids Now!” Infants, children and teens may be able to get free or low-cost health insurance from the state you live in. To find out, contact 877.KIDS.NOW (543.7669) orwww.insurekidsnow.com.

*  Make a list of things that are important to you. Examples are a close location, if you want a male or female doctor, and someone who can understand and speak your language.

*  Look for a doctor who has the training and experience to meet your health needs.

*  Look for a doctor you can relate to. How do you want medical decisions to be made? The doctor alone? You and the doctor together? Interview several doctors before you decide on the one you want. Choose one you feel comfortable with.

*  Ask about office hours and staffing. Ask how long persons usually wait to see the doctor. Find out how many patients are scheduled to be seen in an hour.

*  Ask how payment is handled. Must you pay for your visit at that time? Can you be billed and pay later?

*  Find out what other providers serve as backups when the doctor is away. Ask what you should do at non-office hour times. Ask which walk-in clinic or urgent care center you should use.

*  Find out which hospital(s) the doctor sends patients to.

*  Look for a doctor who is competent and can care for all your general health needs. Ask if and who the doctor will refer you to for any special health needs.

*  Ask relatives and friends if they have been patients of doctors you can choose from and if they would recommend them to you.

*  The American Board of Medical Specialties (ABMS)  –  866.ASK.ABMS (275.2267)  –www.abms.org

*  Medical Association’s “AMA Physician Select” free servicewww.ama-assn.org/aps/amahg.htm

*  The Federation of State Medical Boards  –   888.ASK.FCVS (275.3287)  –www.fsmb.org/members.htm

*  Health Grades. (There is a fee to use this.)www.healthgrades.com

* These Web sites:www.docboard.orgwww.healthfinder.gov

*  Allergist – Diagnoses and treats allergies.

*  Anesthesiologist – Gives anesthetics during surgery.

*  Cardiologist – Diagnoses and treats diseases of the heart and blood vessels.

*  Chiropractor – Manipulates and adjusts the spine for therapy.

*  Dermatologist – Diagnoses and treats acne, skin cancer, and other skin conditions.

*  Emergency Medicine – Specializes in rapid recognition and treatment of trauma or acute illness.

*  Endocrinologist – Diagnoses disorders of the internal glands, such as diabetes and thyroid problems.

*  Family Practitioner – Provides total health care of the individual and the family.

*  Gastroenterologist – Diagnoses and treats disorders of the stomach, bowels, liver, gallbladder, and other organs of the digestive tract.

*  Gynecologist – Diagnoses and treats fibroids, ovarian cysts, and other female reproductive system conditions.

*  Internist – Diagnoses and treats a variety of diseases, especially those of adults.

*  Nephrologist – Diagnoses and treats diseases and problems of the kidneys.

*  Neurologist – Diagnoses and treats disorders of the nervous system, such as Alzheimer’s disease and multiple sclerosis.

*  Obstetrician – Provides care and treatment of females during pregnancy, labor and delivery, and 6 weeks after delivery.

*  Oncologist – Diagnoses and treats all types of cancer and other types of benign and malignant tumors.

*  Ophthalmologist – Diagnoses, monitors, and treats vision problems and other disorders of the eye.

*  Orthopedist – Diagnoses and treats injuries and diseases of the bones, joints, and muscles.

*  Pediatrician – Diagnoses and treats the physical, emotional, and social problems of children.

*  Physiatrist – Provides physical and rehabilitation treatment of muscle and bone disorders.

*  Psychiatrist – Treats and prevents mental, emotional, and/or behavioral disorders.

*  Radiologist – Uses X-rays and radiant energy for the diagnosis and treatment of disease.

*  Urologist – Diagnoses and treats bladder and prostate problems and other conditions of the urinary or urogenital tract.

*  Any unexplained lumps or swelling.

*  Frequent nosebleeds.

*  Blackouts.

*  Dizzy spells.

*  Frequent earaches.

*  Severe depression.

*  Persistent hoarse voice or trouble swallowing.

*  Frequent or painful urination.

*  Breast lumps or pain.

*  Recurring colds, sweating, fever.

*  Blood in the urine or stools.

*  Chronic cough.

*  Swollen ankles.

*  Enlarged lymph glands.

*  Loss of function, stumbling.

*  Severe insomnia or fatigue.

*  Persistent thirst.

*  Convulsions.

*  Chest pressure or pain.

*  Weight loss or gain for no reason.

*  Diarrhea or constipation that does not go away.

*  What is the best time to call?

*  What is the provider’s rule for calling back?

*  Who should you speak with if you can’t talk one-on-one with the provider?

*  What is the phone number for emergency calls or calls when the office is closed?

*  Who can you call if the provider is out of town?

*  Quickly explain why you are calling, especially if you’ve phoned after hours. (Have someone else call if necessary.)

*  Define your problems and symptoms. Write these down and keep them by the phone so you can report them fast and completely.

*  Report results of things you have kept track of (e.g., temperature of 101°F for 2 days, diarrhea that has lasted for 48 hours, etc.).

*  Ask the provider what you should do. Write it down.

*  Have your pharmacist’s phone number handy.

*  Ask if and when you should call back, or if you should be seen.

*  Ask what would require you to go to an urgent care center or to the hospital’s emergency department.

*  Thank the provider for talking to you on the telephone.

*  If necessary, have your medical records, reports, and/or results of lab tests and X-rays mailed or faxed to your provider. Call the provider’s office to find out if your records were received.

*  Plan ahead of time what you want to discuss. Write it down to take with you. Also, make a list of medications, vitamins, etc. that you take. Include their doses. Or, take them in their original containers with you.

*  Your current problems, symptoms, and needs. Read or give a written list to your provider.

*  Any home treatments or self-tests you have done. State what has and has not helped.

*  Your own and your family’s medical history.

*  Your daily living habits (e.g., eating, drinking, exercise, smoking, and sleep habits).

*  Your work, family, and living situations and stresses and changes going on in your life.

*  For an explanation, in simple terms, of: What the provider advises; names and doses of medications, if prescribed; and what the medication should do, how it should be taken, and about side effects.

*  For the costs of the office visit and tests done and if and who you need to call for test results.

*  What self-care measures you should do and when you need to call or see the provider again.

*  For a summary of the office visit to be sent to other providers, if needed.

*  Be honest. Tell the provider all you know and feel about your problem. Things you notice about your health can help your provider make a diagnosis.

*  Discuss anything you’ve done that has helped with symptoms or that has made them worse.

*  Repeat in your own words what the provider has told you with phrases like, “Do I hear you say that…?”

*  Let your provider know if what is being said or prescribed does not make sense to you.

*  Take notes on what is said and what you need to do. If you are confused by medical terms, ask for simple definitions. Don’t be embarrassed by this.

*  Be frank with the provider if any part of the office visit is annoying, such as a lengthy wait or a rude staff member. Be tactful, but honest.

*  Don’t be afraid to voice your fears about what you’ve heard. The provider may be able to clarify any untruths.

*  Find out the best time to call the provider if you have questions after you speak with him or her.

*  Does the provider listen to you and answer all your questions in terms you can understand? Or is he or she vague, impatient, or not willing to answer?

*  Are you comfortable with the provider? Can you express your feelings, and talk about personal concerns, including sexual and emotional problems?

*  Does the provider do a complete job? Does he or she take a complete history and ask about past physical and emotional problems and your family’s medical history? Does he or she find out what medications you take and are allergic to and ask about other matters that affect your health?

*  Does your provider address the root causes of your medical problems or just prescribe medications to treat the symptoms?

*  Are you satisfied with the provider’s substitute when he or she is not available?

*  Is the office staff friendly? Do they listen to you?

*  Does the provider answer your phone calls promptly?

*  Do you have to wait for a long time when you have an appointment?

*  Does the provider have hospital privileges at a respected hospital?

*www.fda.gov

*http://nccam.nih.gov

*http://dietary-supplements.info.nih.gov

*  Keep track of medical bills for each family member.

*  Keep a tally for the total amount spent. Then you can tell when you reach individual and family “deductibles” and maximum “out-of-pocket” expenses. Your insurance plan won’t start paying until you reach your deductible for the year. Once you have reached your out-of-pocket maximum for the year, the insurance plan pays the whole bill on services they cover.

*  If you have met your deductible, and especially if you have met your out-of-pocket maximum, schedule follow-up visits, etc. before the year is over. In other words, don’t wait until January to see the doctor. It will cost you less for a doctor visit or other health care service before the end of the year.

*  Before you go, ask how much the visit will cost. At each visit, ask again.

*  Ask your doctor if fees are negotiable. Ask if you can be charged less, especially if you are on a limited income.

*  Sometimes the doctor’s fee is more than your insurance will pay. If so, ask if your doctor will take what your insurance pays and not ask you for more.

*  Ask if your doctor will give you a discount for paying at the time of your visit.

*  Ask for a statement for your insurance company, if you need it. Ask that the right diagnostic and procedure codes be listed.