When you hear the word “savvy,” you might think of a take-charge person, someone who is assertive and experienced. When it comes to health care, to be savvy simply means you are proactive about your care. Even if you’re naturally quiet or laid-back, it’s important for you to take responsibility for your personal health and seek the best understanding and care possible.
To make the best choices, you need to be a savvy health care consumer—and the following information can help you accomplish that.
The Patient-Physician Relationship
Both the patient and the physician have important roles to play within the health care relationship.
The Patient Role
Research and find a primary care physician (PCP) who provides care that is science-based and state-of-the-art, but who is also considerate and compassionate. Take an active role in choosing and cooperating with your health professionals.
There are things a patient needs to do before, during, and after a doctor’s visit to ensure the most positive outcome. Preparation and communication are key.
The Physician Role
The physician’s job is to accurately diagnose the patient’s problem and effectively communicate the diagnosis and treatment plan to the patient. Consumers have the right to be partners in their health care and should be given information from their physician in a way that is not authoritarian or condescending.
It is important to realize that doctors have different styles of practicing medicine. Some are very paternalistic and determine what is best for their patient without their patient’s input. This may work for some passive patients, but a proactive patient who expects to have full participation in their health care experience will need a doctor willing to hear any questions, fears, or concerns.
At its best, medical care should be a partnership between the patient and physician. It needs to include effective, two-way communication, routine visits, and age-appropriate wellness exams and preventative testing.
The Patient’s Rights to Their Medical Records
To be a savvy health care consumer, you need to know your rights as a patient. Since 1996, all patients’ rights have been protected by the Health Insurance Portability and Accountability Act (HIPAA).
HIPAA is a federal law that created national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge. Under this law, as a patient, whether in a private doctor’s office or a hospital setting, you are guaranteed confidentiality of all of your medical records. Only you can specify who, if anyone, is permitted to view such information.
Furthermore, you have the right, as a patient, to receive a copy of any of your medical records, even the ones sent to your physician. For example, when a woman has a mammogram, the results are quickly emailed to her doctor’s office, followed up by the mailing of two letters: one to her physician with the results stated using the radiologist’s medical terminology, and the other to the patient with the results stated in layman’s terminology. In this case, if you would like to receive both letters, including the physician’s letter with more precise medical information in it, you can request that at the imaging facility. It is a basic right of every patient to have all their medical information.
Choosing a Health Insurance Plan
As a savvy health care consumer, you want to evaluate different health insurance plans and choose the most appropriate one for you. If you have the choice of what plan you will have, consider these important criteria:
Choice of Physicians and Facilities
❏ Are restrictions placed on your choice of physician?
❏ Is your current physician covered by the plan?
❏ Is the hospital you prefer, or where a particular physician has privileges, covered by the plan?
❏ If you must choose a new physician or facility, are services available at convenient times and locations?
Services
Before selecting an insurance policy, you must know whether it covers all the services you are most likely to need. This is especially true for Medicare plans, which typically do not cover dental or vision services unless you have a special advantage plan, which costs more in the monthly premium but is well worth it in the long term. (It even includes fitness and online classes!)
Restrictions and Exclusions
❏ Are there exclusions for any preexisting conditions? If so, how long must you be free of symptoms before these would be covered?
❏ Do any services require pre-authorization (doctor must provide your insurance company with medical justification for a procedure or medication)?
Costs
❏ How much is the monthly or yearly premium, the amount you pay for your insurance?
❏ How much is the annual deductible, the amount you must pay in full before your insurance company will start paying your medical bills?
❏ How much are your co-payments, the amounts you pay out-of-pocket, for treatment at doctor’s offices, hospitals, and clinics? Co-pays for specialists are typically higher than primary care physicians, and emergency rooms are higher than acute care clinics.
❏ If you visit a physician outside the plan (i.e., “out of network”), what percentage of the cost is covered? The portion you pay is called the coinsurance, and it is typically higher when you go outside your plan.
❏ Are there limits on the coverage of your particular conditions?
❏ Is there a maximum limit of coverage, either on a yearly basis or over the life of the policy?
Medication Costs and Concerns
As a savvy health care consumer, you can use these strategies to help control your prescription drug costs:
❏ Ask your doctor if there is a generic substitution for a prescribed brand-name drug.
❏ Check your insurer’s list of covered medications on their website. The drugs will be listed in tiers or levels, with the cheapest, such as generics, at the top, and more expensive brand names at another level.
❏ Obtain prior authorization for any specific drugs you need that are not currently on your insurance company’s list of covered drugs. If your doctor emails or faxes a written explanation of the medical necessity of the drug for you, your insurance company will most likely add it to their covered list of drugs and pay for the drug at their customary rate.
❏ Use the GoodRx card for additional savings with your insurance plan. To learn more, visit goodrx.com.
Now that you know many of the lifestyle behaviors of a savvy health care consumer, I hope you will decide to adopt the ones that are currently missing from your life to promote not only a longer lifespan, but also a better health span or quality of your lifespan.
Your Visit Checklist
Before the Visit
In the weeks or months leading up to your appointment, make a list of the following:
❏ Your primary reasons for visiting the physician, with the most important one listed first
❏ All of your symptoms, including when they started, how long they last, and what makes them worse and better
❏ A detailed and well-organized account of your relevant past medical history and what treatments you have already tried
❏ Medications and supplements, including dosage
During the Visit
❏ Take notes or, with the doctor’s permission, record the session on your phone.
❏ Present the highest priority concerns at the very beginning of the visit.
❏ State your concerns specifically and concisely using the notes you prepared beforehand.
❏ Be open and honest about health concerns and symptoms.
❏ Ask questions.
❏ Participate in the decision-making process about a treatment plan.
End of the Visit
Before you leave the appointment, you should be clear on the following information. If you aren’t, ask your physician for clarification or further information:
❏ The diagnosis (the nature and cause of your symptoms)
❏ The prognosis (the expected duration, course, and outcome of the condition)
❏ The physician’s treatment recommendations and instructions
❏ The follow-up plan (returning for a visit, phoning for test results, reporting any specific signs or symptoms, etc.)
Terry Leitma is a health educator who has taught courses at multiple colleges and universities during her 30-year career. Recently retired, she lives in Delmar, Maryland, and completed her doctoral work in health education at the University of Maryland.
