GUIDE FOR CARE AND SUPPORT DURING SERIOUS ILLNESS
Chapter 4: The Health Care System: Piecing it all together
Questions to ask about your health care system
There are many different pieces to a health care system. Members of a health care team may include: a primary doctor, specialists, pharmacists, doctor's assistants, nurses, health aides, therapists, chore workers, meals providers, transportation services, pastoral care, family, and friends. Trying to know how all these pieces fit together, and know who is doing what, and when, can be a challenge. Here are some questions that may assist in learning more about your health care system, and how to best receive quality care and support.
1. Ask your doctor how to best learn about the health care system he or she uses. Is there someone else in the office that can answer your questions?
2. Who do you contact between appointments with questions and concerns, and what number do you use? In case of emergency, who do you call?
3. When your doctor is not available, who will be providing you with care? What number do you use to contact them?
4. Ask what specialists your doctor works with, and the process of referral. Can you refer yourself to other doctors? Some doctors are part of a practice and only refer to certain specialists. If you want to go to a specialist outside of their practice, ask how you would do it and if you need to pay extra in order to go to a specialist of your choice.
5. Some doctors do and some do not work with other types of alternative care. If you are interested in acupuncturists, naturopaths, chiropractors, massage therapists, etc., ask your doctor about them. You may also want to ask if your insurance covers these services.
6. Ask what hospital(s) the doctors work with. Not all hospitals provide all types of care, or specialize in certain procedures and services. You can contact the hospitals directly and ask for more information on their services.
7. Not all doctors can admit patients to every hospital. If you have a preference for a hospital, make sure your doctor knows about it. Make sure your insurance plan has your preferred hospital in the network you chose.
8. Some doctors are accustomed, and some are not, to working with home health agencies and hospice care. Ask your doctor what home health agencies he/she works with, and how you can have a home health care referral and assessment. Ask about their relationships with other long term care facilities and nursing homes.
9. Not all doctors are the same. It is important to find a doctor whose skills and personality fit your needs. Decide what is important to you and discuss it with your family and doctor. Ask how your doctor will discuss with you and your family the medical diagnosis and care provided. Don't be afraid to ask for a second doctor's opinion or a pathology or radiology report. A correct diagnosis and treatment plan can be life-saving. You want to be absolutely sure and confident that the plan for your health care is the best available. (And don't worry, most doctors are perfectly used to patients asking for a second opinion - it is quite normal!)
10. It is important to have confidence in your doctor. If you decide to change doctors, you may have all of your medical records transferred to the new doctor.
11. Contact your insurance company to determine the type of coverage you have for doctors and specialists, home health care, and other providers. You may ask to talk to a customer representative for your insurance. For Medicare, their toll free number is: 1-800-638-6833. Information is also available at www.medicare.gov.
12. Not all health benefits are provided by insurance companies. Some health coverage is provided by the government, and some directly by an employer. The laws, regulations, and consumer protections that apply to each type of coverage is different. Ask your insurance customer service representative what type of coverage you have, and the process for review of a decision about your coverage. Be assertive in getting the information you need.
13. You are responsible for your health care. Don't hesitate to ask questions or make suggestions. It is your right as a consumer of health care!
14. It is important not to make assumptions. Confirm your understanding of the medical care to be provided and covered by your insurance.
Created by Compassionate Choices.