Being an Informed Healthcare Consumer

Do you know what your insurance benefits are? Healthcare is an ever-changing beast. Insurance, in particular, seems to be the most unpredictable. With costs increasing and benefits constantly changing; do you know where you stand? When choosing a healthcare provider, whether it be a general physician, orthopaedic specialist or even your physical therapist, are you an informed healthcare consumer?

With so many variables, where do you begin? Well, it’s easier said than done, but below are some tips to get yourself on your way to being an informed Healthcare Consumer:

  1. Use Technology — Many insurance companies have helpful websites and apps that will show you where you stand in regards to your deductible, out-of-pocket maximum expenditures and co-pay or co-insurance status. Commonly, you can also search for in-network providers, view past explanations of benefits, get cost estimations and more. There are even special programs, like the Blue Cross Blue Shield of Nebraska Centers of Excellence program. Of course, it can be a bit overwhelming, so calling and talking to a live person may be beneficial as well.
  2. Contact Your Provider — Stopping in or calling your provider’s billing department is a good way to get questions answered. Though keep in mind, providers and organizations can sometimes have dozens of contracts with many insurance providers, so it’s difficult to predict exact costs until the claim is actually submitted. It’s not uncommon to ask your healthcare provider’s billing department for the common codes used for your procedure or treatments and then call your insurance provider to get an idea of costs that you may be responsible for.
  3. Know Your Therapy Visit Limits — For services like physical, occupational and speech therapy, as well as chiropractic and some other services, many insurance providers limit how many visits you get. This can be as few as 15 or as many as 60 or more. Sometimes it’s based on medical necessity. Either way, it’s important to know where you stand, so you aren’t going through all your visits in the first few weeks of a recovery that will take months to complete.
  4. Use Therapy Visits Wisely — Depending on your procedure, talk with your physician and rehabilitation specialist about how long recovery is expected to take, what your visit limit is and what you can do to optimize your recovery in and out of therapy. The days of seeing a patient three times per week are growing fewer as surgical procedures improve, insurance plans become limited and patients become more active in their recovery.
  5. Take an Active Role — Be sure to take an active role in your recovery. While some passive treatments like heat, ultrasound and electrical stimulation feel nice for a bit, the evidence on their true effectiveness is wanting. Patients who seek to be educated and take an active role in their recovery can utilize their visits more efficiently and learn “self-care” techniques – preventing injury recurrence and saving them both time and money.
  6. Bang for your Buck (or Visits) — Be sure whoever is taking you through your recovery journey is educated and licensed to do so. You should be getting quality care and attention from a qualified healthcare professional.; whether it be a PT, OT, PTA, COTA or AT.
  7. Do your Research — It’s easy to choose the convenience of someone close to home or work, but will you get the quality care you deserve? Read reviews and past patient experiences from reliable sources online. Talk to friends, family and co-workers for references on clinics or providers. Research potential providers on their treatment background, education, additional training and certifications.
  8. Jack of all, Master of None — Take note if your provider specializes in what you need. Subspecialties are becoming more common in rehabilitation professionals just like with physicians. Don’t be afraid to ask for and choose a provider that specializes in what you need, be it shoulder, spine, ankle, sports, etc.

Looking for other resources to be a smarter healthcare consumer? Here are a couple:

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