Key Areas to Advocate in Healthcare
“Self-advocacy”, or the ability to speak up for yourself and your own interests, is an essential skill when it comes to navigating your healthcare and finding a doctor. Learning about your eosinophilic condition, identifying your own treatment goals, knowing your treatment choices, and organizing your medical information can lead to a treatment plan that suits you and your caregivers. Explore these important areas to be an advocate for your own healthcare.
Finding a Provider
Spending time researching and evaluating options can help you build a team of healthcare providers to effectively manage your eosinophilic disorder. Here’s a list of questions to think about when you’re trying to start care with a new provider:
Thinking about Insurance and Costs
How does this provider fit into my health insurance plan? Do I need a referral from my Primary Care Provider to see them? Are they connected to hospitals covered by my insurance? How much will I have to pay out of pocket?
Considering Personal References and Communication Style
Do I know anyone who has seen this provider? What was their experience like? What do others say about the doctor’s communication style? Is this feedback also supported by reviews on online physician rating sites?
Evaluating Accessibility
How far is the provider’s office? Can I easily get there? Is their office compliant with accessibility accommodations I physically require? Do they offer video appointments? How soon can I get an appointment? Can I talk to someone in the office if I have questions between appointments?
Evaluating Experience and Specialty
Is this provider experienced in treating eosinophil-related diseases? Does their website profile list any of their research interests that could benefit me?
Checking Access to Other Specialists
Does this provider have access to a wide range of other specialists that might be of benefit to me? How will this provider work with these other specialists to coordinate my care?
Understanding Healthcare Costs
Knowing about your out-of-pocket costs can empower you to make informed decisions about your eosinophilic care. Your healthcare expenses will vary depending on your insurance coverage. You may be responsible for costs not covered through your insurance including copayments, coinsurance, deductibles, prescriptions, and monthly premiums. Here are some steps to help evaluate your healthcare costs:
Review Your Insurance Plan
Becoming knowledgeable about your insurance plan’s unique features is important to understanding your own costs. Know your own premium, annual deductible, costs for seeing in-network versus out-of-network providers, and your copay responsibilities. Determine if your plan requires your primary care provider to make a referral before seeing a specialist. You may have to pay more if you make an appointment with a specialist without a referral.
Understand Prior Authorization Policies
Prior authorization is a process used by health insurance companies to determine if they will cover certain medications, treatments, or procedures before they are performed or prescribed. It requires healthcare providers to obtain approval from the insurance company before providing certain services to ensure that the treatment is medically necessary and meets the insurer’s criteria for coverage. Proceeding without approval might cause you to be fully responsible for related costs.
Healthcare providers will typically coordinate prior authorization directly with your insurance company on your behalf. The process often involves healthcare providers to submitting relevant information, such as medical records, test results, and treatment plans, to the insurance company for review. The insurance company then evaluates the request based on their coverage policies and medical necessity criteria. If the request is approved, the treatment or medication is covered according to the terms of the insurance plan. If denied, the healthcare provider and patient may have the option to appeal the decision or explore alternative treatment options.
Understand Billing Process and Terms
Explanation of Benefits (EOB):
After a medical visit, your health insurance sends you an EOB detailing costs, services, insurance payments, and what you’ll be billed. EOBs are typically also available online in your provider’s medical portal.
Medical Bill:
Your provider will send you a medical bill outlining what costs have been paid by your insurance and what you will be responsible for paying yourself. Doctors and hospitals often send separate bills. If you want to know exactly what you’re being charged for, you can request an “itemized bill’” from your healthcare provider. This detailed bill breaks down each service you received, which is useful if you had care from different providers on the same day, such as in a hospital. You can also ask for a “superbill”, which lists the services you received from a provider over a set period.
ICD Codes
ICD codes, or the “International Classification of Diseases” codes, are a standardized set of codes across the entire healthcare system that represent specific medical procedures and conditions. You will see ICD codes on your health record and on medical bills. Commonly-used ICD codes for eosinophilic conditions are available on APFED’s main website.
It’s a good idea to check your medical bills often. It is not uncommon for medical bills to contain errors. By looking at your EOBs and itemized bills and understanding the ICD codes related to eosinophilic disease care, you’ll be able to catch coding mistakes, duplicate charges, and unauthorized fees.
Ask for Help
There are resources that can help you manage insurance benefits and financial aspects related to your medical care.
Benefits/Human Resource Manager:
If you receive health insurance coverage through your employer, your human resources department will have a point person you can contact to help you understand your benefits. They can also help you advocate for a particular service or coverage.
Case Manager/Navigator:
Some healthcare institutions offer professionals dedicated to helping you navigate your care, including your financial responsibilities. Hospitals often have social workers who can connect you with a variety of resources.
Know Your Rights
In January of 2022, a federal law called the No Surprises Act went into effect to help protect people from unexpected medical bills. Visit the Medical Bill Rights Menu to understand these protections and get linked to resources to assist with medical billing issues.
Additional Resources:
- Assistance Programs and Resources for Eosinophil-associated Diseases
- Tips to Help You Manage the Financial Impact of Illness – National Patient Advocate Foundation
- National Financial Resource Directory – Patient Advocate Foundation
- No Surprises: How do I read my medical bill? (Centers for Medicare and Medicaid Services)
- Know your rights and protections when it comes to medical bills and collections (Consumer Financial Protection Bureau)
- ICD-10-CM Codes for Eosinophil-associated Diseases
Organizing Your Medical History
People with eosinophil-associated diseases sometimes have more than one healthcare provider that provides care. Being able to easily access important information about your medical history can help you relay information to team members. If you need help getting started, you may find this appointment summary template useful.
Asking Questions and Sharing Concerns
While healthcare providers play a crucial role in your health, your involvement is equally important. Asking questions and expressing your concerns during medical appointments helps build trust and ensures you get vital information to make decisions about your treatment.
Preparing for your visit by jotting down questions in advance can maximize your appointment’s effectiveness. This ensures you receive all the necessary information from your doctor and that your concerns are addressed.
Visit the Self-Advocacy in Clinic section of this website for more in-depth ways to prepare for and participate in a medical appointment.
