specialists

Simple Ways to Get the Healthcare You Need Without Overspending

Julie Rains — Mon, 06 May 2013 09:48:33 +0000

Getting the right healthcare services can be difficult under any circumstance.

In the past few years, my family members and I have had some relatively minor but pressing problems requiring medical attention. Making sure we had proper care at a reasonable cost was much more difficult than expected even though we have excellent insurance coverage. While stressful, these experiences improved my skills in navigating the healthcare system and, most importantly, advocating for myself. (See also: How to Find Free (or Cheap) Health Resources)

Here are lessons learned that I hope can save you time, money, and frustration.

Know Your Insurance Coverage

Reading your benefit guide is not the most exciting thing to do, but checking out what’s covered and what’s not is extremely useful. You don’t have to commit the handbook to memory, but you should read about coverage for preventive services, emergency services, and any other services that you are likely to need in the next year or so. This information can be beneficial when having a conversation with your physician or her staff about appointments, procedures, etc.

Don't Rely on Office Staff for Insurance Details

I have found that the physician’s office staff often provides misleading information about insurance coverage with advice ranging from ideal situations to worst-case scenarios. Certainly, they are trying to be helpful, but inaccurate guidance doesn’t facilitate getting better care or control spending.

For example, staff members often mention that insurance will not cover an annual physical unless an entire year has lapsed between the last one. While this may be true for many people, my insurance coverage allows such a visit once every calendar year. So, if I need to schedule a physical for May even though I came last year in June, I can still receive coverage for this earlier-than-usual appointment.

At the other extreme, physicians and their staff have told me that certain procedures are covered by insurance. Those healthcare professionals are unusually optimistic and often wrong. Sure, the treatment may be covered in the sense that a discount is available or charges are applied to a deductible (which could be $500 or $5,000, depending on your plan). At the very least, you need to know the out-of-pocket cost, which often means asking pointed questions of the billing staff and insurance company.

Choose What Works for You, Regardless of Coverage

In an ideal world, your healthcare provider recommends the most appropriate screening, diagnostic test, and treatment plan and your insurance covers the cost. And, much of the time, your needs and coverage match.

But sometimes, needs, recommendations, and coverage are out of sync. At these times, it’s helpful to consider the best course of action plus all of the costs involved in getting care.

For example, when I needed treatment for a running injury, my insurance plan covered physical therapy but not massage therapy. However, the cheaper approved therapy required numerous visits and had limited effectiveness whereas the more expensive, non-traditional therapy involved just a few visits. The non-covered treatment ended up being less costly in terms of money and time than the covered one.

In her article on getting medical care in pregnancy without traditional health insurance, Linsey Knerl mentions that you may be able to control costs associated with certain diagnostic tests. She recommends that you ask about the tests your physician may order routinely and make an informed decision on what tests to perform. This advice is sound whether you have insurance or not. Similarly, the Choosing Wisely website notes procedures that are often performed but may be unnecessary.

Remember that your time is valuable and even relatively small co-pays can add up to large expenses. Looking at the big picture and not simply coverage for an individual visit or procedure can help save money plus give you what you need.

Don’t Be Afraid to Enlist the Help of a Specialist

There seem to be many hurdles to accessing specialty care. The best and most cost-effective method is to receive a referral from your primary care physician. Ideally, your physician will recognize when specialty care is appropriate and refer you to the right type of doctor or therapist.

What makes the process difficult is that you often have to navigate various sets of rules:

Primary care physicians and their offices have internal procedures for referrals.
The insurance company has its guidelines about paying for visits to specialty providers.
Specialists often have their own sets of rules about referrals; some take physician-referred patients only, whereas others allow self-referrals.

While it’s true that your treatment may not be covered by your insurance company if you don't follow all the rules, you can still see a specialist without getting a referral.

Be careful to select the right type of specialist. In his book, "The Thrifty Patient: Vital Insider Tips for Saving Money and Staying Healthy," Davis Liu, M.D. references a study indicating that patients choose the wrong specialty area 60% of the time, which ends up costing more time and money than necessary. To prevent this kind of overspending, do your research and consult with your regular physician about the next step in the diagnosis or treatment of an illness, injury, or condition.

It's a good idea to investigate out-of-pocket costs before your appointment. But you may be pleasantly surprised to find that your insurance covers the visit and treatment whether you stick to everyone else's protocol or not.

Use Your Insurance Company as a Resource

This approach may seem like aligning yourself with the enemy. But some insurance companies offer resources beneficial to navigating the healthcare system.

On my insurance company's website, there are physician performance ratings, updates on claims status, explanations of prior authorization requirements, details on wellness programs, and more. This online information has given me better understanding of administrative procedures and helped me to make decisions on healthcare services.

The customer service representatives have also been helpful by answering questions about coverage based on my circumstances, accelerating the process of getting a pre-authorization, and straightening out billing issues. They have provided clear direction and saved me time that I would have otherwise spent dealing with medical office staff.

Get the Right Physician and Practice for You

Finding the right doctor’s office and physician requires thoughtfulness about your own needs and research on credentials, availability, and more. But your selection can make getting what you need easy, especially if your style of communication meshes well with the physician and staff, or maddeningly difficult, if you don’t understand each other.

For example, the diagnosis of an injury may be delayed if your physician doesn't grasp the severity of your pain following an accident. Treatment and recovery may also take longer if warning signs of complications and follow-up procedures are not explained thoroughly. So finding someone who listens, knows how to ask you questions, and makes sure you understand next steps is essential.

Create a List of What's Important

Make a list of what's important to you. Mine includes a commitment to personalizing care, the ability to make clear and accurate recommendations with a bias toward non-drug interventions, and a professional, knowledgeable staff. Whatever you value, look for a physician that matches your preferences.

Online review sites, such as Healthgrades.com, and recommendations from friends can be helpful but may not give you the full picture. The best reviews are not numerical rankings only but narratives that offer insight into the physician’s philosophy and strengths.

Objective measures are also useful. Start by checking for disciplinary actions on your state’s medical board website.

Continue by researching clinical quality. My insurance company's website provides information relating to physician performance on certain measures relating to screening recommendations. Interestingly, some popular physicians perform below expectations according to these ratings, illustrating that friendliness doesn’t necessarily equate to appropriateness of care. Ideally, find someone who has excellent clinical capabilities and treats patients well.

Whether you have a high-deductible health plan or a more traditional one, getting what you need without overspending requires effort. What I have discovered is that engaging healthcare professionals who are interested in addressing concerns and solving problems (rather than chasing insurance coverage) has been most beneficial to my family and me.

What are you doing to make the most of your health care dollar?

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This article is from Julie Rains of Wise Bread, an award-winning personal finance and credit card comparison website. Read more great articles from Wise Bread:

Your Next Hire: Specialist or Generalist?

Thursday Bram — Wed, 06 Jul 2011 18:05:39 +0000

Link:

http://www.openforum.com/articles/your-next-hire-specialist-or-generalist

When you’re considering bringing on a new employee for your business, you probably have a few ideas of just what she or he will wind up doing in the office – a list, perhaps, of things you want to get off your desk. But it’s tough to decide whether that person should be a specialist, and able to serve one key function in your business, or a generalist, and able to handle everything that comes up in the course of a business day.

The entire hiring process can be a little intimidating. The decision of whether that perfect hire should be a generalist or a specialist is just one more step – but a necessary one.

The Argument for the Generalist

As a small business owner, you yourself are a generalist. You have to know how to handle bookkeeping, human resources, marketing, and everything else that comes up. You probably have some sort of specialized knowledge, though, that led you to go into business in the first place. If you can bring in someone to handle all of the general stuff that comes up every day, you can focus your attention on the work that is the mainstay of your company.

It can be relatively easy to find someone with the general skills to handle the sorts of administrative work that are necessary to keep a business humming along. There are a variety of job titles that can go with that position, from office manager to administrative assistant. There are also options to use virtual or telecommuting staff to fill such a position. In fact, my first hire was a virtual assistant who handled a wide variety of tasks and never came into the office.

You should expect to need to train a generalist, perhaps more than you would a specialist. That’s because a generalist needs to learn your systems for all parts of your business, as well as pick up any general skills he doesn’t already have. That can be an important consideration when you know you want a generalist, but aren’t sure just how much of a generalist you need.

The Argument for the Specialist

For other companies, though, a specialist may be the better choice. Because you’ve likely already got a system in place for running the day to day operation and probably figured out how to keep the administrative stuff to a minimum (so you can actually work), bringing in a specialist who can directly contribute to improving your business’ ability to earn money will help your company grow.

That first virtual assistant I hired? I eventually let him go, in part because I could always handle tasks faster and because with my business model – services based – it was easier to build up more income by bringing in others who could provide the same sorts of services I do.

It can be harder to find a specialist who has the exact skill set you need, but it’s generally worthwhile to take the time to find someone who has at least started to build up that skill set already. Training a specialist can take enough time and effort away from your own work that it is worthwhile to pay more for an employee that already knows what they’re doing.

Deciding What’s Right for Your Business

If you could do more to directly earn money for your business by passing the genralized stuff off of your desk, the decision is pretty clear. Same goes if you could sell more products or take on more clients if only you had an employee with a certain skill in your office.

Of course, it’s rarely that easy.

Few businesses need just one thing by the time they’re ready to hire their first employee. It’s tempting to put off that first hire for as long as possible, if only to avoid paying out a salary until you’re absolutely sure that you can afford it. But by that point, it feels like you could use a full time bookkeeper, a couple of specialists, an administrative assistant, and maybe someone to make coffee for everyone else. Scaling up at a speed that works with your business is a balancing act.

If you really can't decide, consider a few alternatives. Depending on your business, a part-time contractor or freelancers brought in on a per project basis might be the answer.

Ultimately, you may find that the most important thing is hiring the right person, irrespective of generalist or specialist skills. He might be the right personality fit, or the right person in terms of availability or some other characteristic entirely. Make sure you’re getting the right package, not just someone who fills one specific requirement. After all, the right person ought to be able to meet your business’ needs in more ways than one.

This article is from Thursday Bram of Wise Bread, an award-winning personal finance and credit card comparison website. Read more great articles from Wise Bread: