Empowering People to Be Their Own Best Advocate When Entering the Healthcare System
The Healthcare system is like no other service we use in our daily lives. The Healthcare system is complex, fragmented, costly, and can be dangerous. Most of us were never trained in how to use the healthcare system so it works for us when we need it. Learn how patients and their families can be their own best advocates when navigating the complex healthcare system.
Why Families Need Empowerment
The question of why patients and families need empowerment surfaces frequently. Consider the complexity of the US health system and your ability to navigate it. Challenges like health status, age, income, employment status, insurance coverage options, and provider availability in your area are some of the things that can impact your ability to access healthcare. For those with chronic, catastrophic, or overwhelming medical or mental health conditions, one’s ability to manage their or their family’s care can be overwhelming. People need to be empowered to navigate the complex healthcare system.
Decision Making: Being the Best Advocate
When one is sick and focusing on their illness, they may not have the ability to think beyond their immediate needs and the consequences of decisions being made. Knowing the questions to ask and advocating for needed and covered medical services takes knowledge, initiative, resourcefulness, and accountability. Making the wrong decision or not acting in a timely manner can have a significant burden on your health as well as your finances.
Practical Advocacy Tips
- Get a notebook to keep important information about your doctors; their names, phone numbers, and dates of your appointments
- Keep track of any testing you are asked to have done. Note the type of test, the date, and the results
- Keep a medication list; include all supplements and herbal preparations. Write the name of the drug, the dose and how often you take each medication, and the reason it’s being taken. For example, diabetes, heart disease, or an infection. Note if you have any reactions from the drug.
- Take notes when you talk to any medical professional or your insurance company. Write the date of the call/conversation, who was present, and what was said. Is there any follow-up you must do? Note if there is any follow-up the person you are talking to you has to do. If there is any follow-up, put a note on your calendar for the date the follow-up is due. This will remind you to check to see what your test or lab work found. Don’t ‘assume’ someone will follow up. If you don’t hear anything, take the initiative to follow up yourself.
- Explore the use of various digital apps for helping you communicate with the care team, remind you to order or take medications, track your Advance Directive, or manage your condition.
Not all insurance is the same!
People need to understand their insurance coverage. Take time to review your policy so you understand your insurance coverage. As each policy is different you need to know about your policy. When you get new insurance, ask for a member handbook. The member handbook explains what your policy covers and what it does not cover. There will also be information on exclusion periods, deductibles, out-of-network, co-pays, and pre-existing conditions which may result in barriers to accessing much-needed medical care.
Depending on one’s insurance coverage you may not be entitled to all the care and services needed. Out-of-pocket expenses also vary based on insurance coverage. In some circumstances, your doctor or specialist can write a letter with details as to why you need a test, equipment, or extra time in the hospital. This information is valuable and gives your insurance company the information they need to approve the request or make an exception to the policy.
Being an active member of your team allows you to ask questions, so you understand everything that is happening. By understanding your diagnosis and plan of care you will have a vested interest in helping the plan will work.
Resources for Empowering
Judith and Anne will provide more tips to empower you to be your own best advocate, so you get the care you need when you need it at the right time and in the least restrictive setting.
If you have any topics, you would like us to cover, please put your request in the comment section and we will address them in a future post.
Judith & Anne