This is Part One of an ongoing series based on our Cover Feature from Doctors Quarterly’s Fall ’18 Issue.
Doctors Quarterly was established because the Healthcare Practitioners and health related professionals who provide educational information in Doctors Quarterly magazine or on the Your Health University YouTube channel believe that “An Educated Patient Is the Best Patient” and they recognize the benefit to their Patients/Customers of contributing to their education. That education involves three primary areas: understanding and being truly informed about medical conditions and treatments; understanding the administrative side of healthcare; and understanding the insurance/billing side of healthcare. Without this understanding, confusion and even frayed tempers can result which is counterproductive for everyone concerned. Doctors Quarterly is here to help.
Each issue of Doctors Quarterly will address a topic or topics of interest such as the medical, administrative, lifestyle, or financial components leading to overall health of the Mind, Body, and Spirit.
Healthcare is a complex and interrelated topic and no one person or agency or modality has all the answers. Our intent is NOT to be a substitute for everyone’s responsibility to do their own due diligence on these topics. Our intent IS to provide some insight so that you can then go to the appropriate expert/agency for specific answers.
Before getting to our first questions, a word about the realities of Healthcare that impact Patients and Providers. Healthcare is among the most heavily regulated businesses in America. In the attempt to ensure each Patient gets the best treatment possible and that they and their privacy are as protected as possible, federal and state governments and then medical boards in each state have promulgated regulations that Providers and Patients must follow. Contracts with health insurers (United, Humana, Kaiser, etc.) also contain policies and procedures that Providers must follow, and the contract each patient signs with an insurer dictates what that plan will cover along with co-pays and deductible amounts and the Provider cannot deviate from those provisions. All of this can result in frustration for the Patient when confronted with seemingly redundant paperwork or with administrative procedures or billing issues. One way to minimize frustration is education so that Patients can understand WHY even if they are being inconvenienced. This all leads back to “An Educated Patient is the Best Patient” and Doctors Quarterly’s part in that.
With all that as background, in each issue of Doctors Quarterly we will address a question or two in an effort to dispel confusion and frustration through education. We’ll follow the general path illustrated on the cover of this issue starting with two of the topics that can frustrate patients: Insurance; and Forms needing to be filled out.
QUESTION: When I’m making an appointment, why am I always asked if I know if the Provider is “In-Network” for my insurance plan? Why doesn’t the clinic/hospital know that? And what difference does it make anyway?
ANSWER: If your Provider is not “in-network” with your insurance plan, your Provider cannot bill for services rendered to you. You will then be “self-pay” which means you will pay the Provider’s self-pay rate “out of pocket”. Most insurance plans specify that it is the Patient’s responsibility to make sure their Provider is “in-network.” Since the clinic is not the broker of your contract with your health insurance plan, relying on the clinic to check puts you at risk of an unexpected bill. It is in your own best interests to check with your insurance plan to be sure your Provider is “in-network.”
QUESTION: What is the big deal about “Informed Consent” and signing an Informed Consent Form?
ANSWER: Informed Consent is the essence of “An Educated Patient is the Best Patient”. The Provider-Patient relationship is based on the trust a Patient places in their Provider which starts with the Patient being informed of the diagnosis and treatment plan prescribed by the Provider. The Informed Consent Form serves two vital purposes. First, it lays out the treatments you may receive and the potential consequences of those treatments. It is your responsibility to be sure that any questions have been answered before you sign that form. Second, by signing the Informed Consent form you are giving permission for the Provider to provide medical services to you during treatment. Because of the importance of Informed Consent and also to alleviate concerns a Patient may have about an upcoming treatment, or to give the Patient Pre and Post treatment instructions, some Providers are taking the extra step of putting educational videos online so the Patient can see and hear what to expect before coming into the clinic for treatment. Having seen the video(s), when the Patient then gives their Informed Consent, that Patient is truly Informed. Go to: YouTube and then Your Health University to see examples of educational videos with many more to come.