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PTSD Professional Perspective: Five Tips to Navigating the Healthcare System

Posted Feb 25 2011 6:23am

Today’s guest post author is a terrific voice advocating for how to become an empowered patient. Over a decade of chronic illness and PTSD symptoms I discovered how important becoming an empowered patient is, so I’ve been looking forward to Hari Khalsa’s tips to help everyone put a little more muscle into their PTSD symptoms management.

The healthcare system can be web of confusion.  It is easy to feel overwhelmed by the prospect of making a call to your insurance company, or to find a doctor, or understanding a new diagnosis. Accessing the information you need from the healthcare system can be a daunting, stressful and exhausting task.  As a healthcare advocate, I navigate the system everyday for my clients and know the barriers and frustrations involved.  Over the years, I have developed techniques to get successful results.  I would like to share five of these tips to assist you with better results while dealing with the healthcare system.

1.

Know what your insurance policy covers.  If you have a hard copy, take the time to read the details. If there is no hard copy, most insurance companies have all details of plans available on their website.  By reading the plan, you will know co-pay amounts, what needs prior approval, how much is the deductible and what is considered out of network.  This information can make a difference in knowing your cost for different procedures, hospitalizations and doctor’s visits.  It will also give details as to the appeals process.

2. 

Have a list of prioritized questions.  Many doctor’s visits are time limited and rushed, so it is important to know what are the most important questions to get answered.  If you have researched a topic, bring the information with you.  Some doctor’s like informed patients and appreciate the information but not all.  If your visit is about a new diagnosis, medication, new symptoms or concerns, bring someone with you.  This person can take notes, read your question list and be a general support.  Many people forget what was told to them during the visit.  Do not hesitate to call the doctor’s office after the visit, if you have further questions or are not clear on what was discussed.  Ask to speak with the doctor’s nurse or medical assistant.  If your doctor is set up with email, send one asking for clarification.

3

If there is a new diagnosis, chronic illness, need for a radiological tests, surgery or procedure, get a second opinion.   Medical professionals do not always agree on the diagnosis or treatment.  A new set of eyes can read a report, lab or radiological films differently.  In order for you to make an informed decision about your healthcare, you will need to know all your options.  Insurance companies generally pay for a second opinion and even a third or fourth opinion.  Your doctor will not drop you for getting a second opinion. Many doctors appreciate a second opinion.

4.

First take a deep breath and exhale!  Have all your information in front of you including your policy number and if applicable the insurance explanation of benefits. If you are investigating a claim, it helps to know what your policy covers.  Insurance companies do make mistakes will make adjustments.  If you have been denied coverage, ask exactly why it has been denied.  Sometimes, it needs to go back to the doctor to recode or other times the insurance company will resubmit it.   Be prepared to be on hold.  Wait times can be as long as thirty minutes especially on Mondays.  Take the name of the person you are speaking with and write down the conversation.  If you feel you are not getting anywhere with the customer representative, ask to speak with a supervisor.  If you are not satisfied with the information, call back.  You may get new and helpful information.

5.

The federal government passed a law in 2002 called the Health Information Privacy and Protection Act, HIPPA.  This bill was enacted for  patients to have control over their medical records as to privacy and personal access.  .  No medical facility or practice can deny you a copy of your records.  The law is designed to protect you not the facility.  It is also your right to make corrections of the records if there is any misinformation.  You can receive a copy of your records by filing out the required form.  You can also put the name of anyone who you give permission to also view your records.  Receiving records can take up to thirty days but most take between one to two weeks. You must be told exactly how long it will take.  If you have any difficulty with the form, the medical records department or you are refused access, contact the HIPPA compliance person.  Every medical facility and practice must have a person who oversees compliance. If you do not get your records, contact the state HIPPA compliance office.  Mental health medical records are designated to have a separate chart to ensure complete privacy and security.

If you have questions, please visit my website www.healthcarewhisperer.com. Go to the page called “Ask Hari“. . You can ask any question and I will get the answer to you without delay.

Hari Khalsa is the founder and owner of Healthcare Whisperer. a patient advocacy and healthcare navigation business. She is a family nurse practitioner dedicated to assisting people receive the proper services.  She received her BSN/RN from Hunter College, New York and MSN/FNP from the University of New Mexico, Albuquerque. ?She was trained in medical acupuncture from Harvard Medical School, Continuing Education.  She studied homeopathy and Ayurvedic medicine?in India. She has been a Kundalini Yoga and meditation practitioner for 35 years. Before starting Healthcare Whisperer, she practiced in a variety of settings from HIV/AIDS, community and international health, and family practice. Her years in family practice, showed her first hand the difficult time people were having navigating the healthcare system and getting the services needed.  ?She decided to become an advocate to relieve some of the burden and anxiety people face when in healthcare crisis.

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The opinions in this post are solely those of the author. To contribute to ‘Professional Perspective’ contact Michele .

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