There are few classes we take throughout our education and upbringing that have a lasting impact on our lives. Outside of the core subjects of math, science and English, few classes really equip you with tools that will make a marked difference in managing your life. With these classes under your belt, what do you need? How about Auto Tech or Home Eco? Changing tires and baking a cake sure can come in handy. Or a personal finance class, perhaps? Knowing how to calculate interest on a loan or investment is clearly invaluable in making tremendously important decisions. So, why isn’t there a healthcare class? What’s more important than learning how to manage your care clinically and economically? Or better put, understand how the services you might need are delivered, who they are delivered by, and how much those services cost. Remember your first “real” job out of college? HR provided you with your health insurance plan information and it might as well have been hieroglyphics. You had no idea what your prescriptions will cost, but you already researched asset allocation for your 401(k) and knew what compounding interest meant. Upon our release into the wild, most of us are hopelessly lost in navigating healthcare. So, without further ado, let the education begin. Below are some pointers and questions that serve as a crash course (grave apologies for that pun in our ortho trauma blog) to protect yourself and your wallet when seeking serious medical care:
Is the facility and surgeon in network? – Surgeons are either employed by a hospital/healthcare system or they are independent. They are paid separately from the hospital by insurance or the patient. While it makes good sense for a surgeon to work with insurance plans that contract with hospitals in their practice’s community, it is not always the case. If you are in a hospital and have been told that your surgery is scheduled, ask who the doctor is and what insurance they take. If the surgeon does not accept your insurance, and the procedure is non-emergent, ask for another surgeon.
What are the fees? You are so quick to ask how much your car will be to fix or your toilet to unclog. Why do you feel awkward and shameful asking your surgeon and facility what their fees are? Go on. Ask. Most places won’t give you a straight answer, but better to know before than after, even if you have no choice. At the very least, you are sending a message that says you care about the cost of your care. That gets people thinking.
Insurance is not some magical entity that picks up the whole tab. The catch-all phrase leading us off the cliff right now is “Insurance covers that.” Newsflash, insurance isn’t covering nearly what it once did. Even if you have good insurance, assume the worst. Healthcare costs are being shouldered more and more by patients, so you have to ask more and more questions about cost to protect yourself.
If a device is required, how much does it cost and is there a high-value equivalent? Sadly, given the nature of traumatic injury, we don’t always have the option of discussing device selection with our surgeons. However, if you present with a broken wrist, for example, your surgery can and most likely will be scheduled a few days or a week out. With that, you have plenty of time to ask about the device being used, its cost, and whether other brands offer better value.
Is fixing my injury your specialty? You’ve presented in the ER with a shoulder fracture. The orthopod on call is a general orthopaedic surgeon and hasn’t done a proximal humerus fracture in eight months. While fixing shoulders was part of their training, just because you “can” doesn’t mean you should. With the right surgeon for the right case, likelihood of revision goes down, and therefore, the cost of care does too. If you still have your faculties upon arriving at the ER, ask for a specialist.
Can we do this in an outpatient facility? ASCs have been increasing in popularity and capability for several years now. This is largely due to the fact that patients get much better value in an outpatient facility when compared to inpatient facilities. Post-op release is faster and data show recovery at home, if possible, is the way to go.
So there you have it. A five minute read might have just saved your life….and your wallet. Education is such an important part of correcting the trajectory US Healthcare is on. If we empower ourselves with information, we can learn how to change things ourselves faster than a spare tire.