Creating a better health care consumer

As health care professionals, we understand the ins and outs of health insurance, but what about the people we serve? I think we all know the answer to that. This quick guide can help you walk them through some steps to becoming a better health care consumer in 2021.

Consumers’ lives are busier than ever. Health insurance has consistently been an area that isn’t prioritized, and that remains the case in today’s landscape. Truth be told, someone may spend hours researching reviews for a purchase on the internet or deciding what to watch on a favorite streaming service, but when it comes to health insurance, the people we work with rarely take the time to understand their benefits or make decisions that will save them money in the long run. So as a health care professional, here are some basic guidelines to help us all understand how we can be better health care consumers. It starts with teaching them the right questions to ask, followed by cost breakdowns and learning how much to spend. 

Ensure they understand their plan options

Making careful health care decisions is vital for keeping personal health care costs down. The insured can control out-of-pocket costs by carefully reviewing health insurance plan options and choosing the one that best fits their needs. This seems obvious, but it’s not for the typical consumer. It feels so overwhelming if you don’t understand the subject matter. Encouragement goes a long way toward helping people delve deeper into the material. And simplification is key.

For example, if the insured has medical problems or recurring medication, they might want to pay a higher premium for more coverage and a lower deductible. If the person is generally healthy and rarely needs to visit the doctor, a high deductible health plan (HDHP) with lower monthly premiums might be the most cost-effective option.

When in doubt, ask the doctor

Patients often accept their doctor’s advice without understanding which treatment alternatives are available, and what—if any—differences there are in cost and effectiveness among those alternatives. A few simple questions can help them decide which treatment plan is best for both their health and their wallet. They should ask questions such as:

• How much will my treatment cost?
• Can I be treated another way that is equally effective but less costly?
• What are other options – even if they cost more but are less invasive?
• What are the risks?
• What are the side effects?

Having a conversation with their physician can help them better understand how care and recommendations affect their health and plan costs. Empowering each person to understand that those are appropriate and smart questions helps, as well. 

Make careful decisions about prescription drugs 

Many people incorrectly believe that there is a significant difference between generic and brand-name prescription drugs. However, generic drugs are only approved by the Food and Drug Administration (FDA) if they have the same active ingredient, strength, dosage, form, and route of administration as the brand-name drug.

Generic drugs may contain different inactive ingredients, but the primary differences between generic and brand-name medications are typically only in the name of the drug and the cost. Generic drugs cost less but still provide the same health benefits as name-brand drugs.

The next time a doctor writes a prescription, the patient should ask if a generic equivalent is available. The physician can instruct the patient’s pharmacist to use a generic substitute. 

Choose in-network providers 

Seeing a doctor in the person’s insurance plan’s network is typically much less expensive than out-of-network health care providers. When helping them choose a plan, make sure that they have access to the doctors and hospitals they will want to visit when care is needed. 

Seek outpatient care  

Outpatient care is often a less expensive alternative to inpatient care, and it does not necessarily sacrifice the quality of care. If they need to have surgery, they should ask the doctor if laboratory tests could be done in a clinic rather than in a hospital. In addition, the surgery itself can sometimes be performed in a clinic or an outpatient surgical facility, giving them the ability to recover in the comfort of their home instead of in a hospital. If outpatient care is a reasonable alternative for the specific care they need, it can help them save on out-of-pocket expenses. 

Review benefits and bills

When someone needs medical care or medications, reviewing their insurance coverage is a critical first step to understanding the costs for which they will be responsible. When they receive the bill and explanation of benefits (EOB), they should carefully look it over to ensure that they were charged correctly. Errors can often occur in medical billing codes and in coverage, so taking a few minutes to read through the bill could save them money by catching potentially costly mistakes.

In general, being a better health care consumer means taking the time to learn about insurance and medical care options, choosing the plan and treatments that are best, and reviewing medical bills to ensure the charges are correct. It may seem like these are something that every health care consumer would do, but the facts show otherwise. It is best that we, as professionals, recognize how we can assist and educate the consumers we work.