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Deb Gordon

Deborah D. Gordon has spent her career trying to level the playing field for healthcare consumers. She is co-founder of Umbra Health Advocacy, a marketplace for patient advocacy services, and co-director of the Alliance of Professional Health Advocates, the premiere membership organization for independent advocates. She is the author of "The Health Care Consumer's Manifesto: How to Get the Most for Your Money," based on consumer research she conducted as a senior fellow in the Harvard Kennedy School's Mossavar-Rahmani Center for Business and Government. Deb previously spent more than two decades in healthcare leadership roles, including chief marketing officer for a Massachusetts health plan and CEO of a health technology company. Deb is an Aspen Institute Health Innovators Fellow, an Eisenhower Fellow and a Boston Business Journal 40-under-40 honoree. Her contributions have appeared in JAMA Network Open, the Harvard Business Review blog, USA Today, RealClear Politics, The Hill and Managed Care Magazine. She earned a BA in bioethics from Brown University and an MBA with distinction from Harvard Business School.

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The Healthcare Consumer’s Survival Guide to Coronavirus

The Healthcare Consumer’s Survival Guide to Coronavirus

The Healthcare Consumer's Survival Guide to Coronavirus

During the pandemic, we should think as much about "buying" health care as do about buying toilet paper. An expert shares four ways to take charge of your healthcare costs.

Women's Health Policy

At the first inkling of a looming global pandemic, many Americans' instinct was to do what we do best: go shopping.

We did such a good job stocking up on supplies that we collectively wiped out store shelves and created a run on hand sanitizer and toilet paper. I'm not judging; I am actually wondering if I bought enough to survive an apocalypse.

But in our quest to outlast the pandemic, we should not overlook the most important category to shop for right now: health care.

Shopping in a health care context would mean taking some control of our health care decisions even as the coronavirus spread feels largely out of our control.

In an otherwise uncertain time, here are four ways to take charge of your health care even as you may feel like you're waiting for another shoe to drop.

1. Identify Your Point of Care

Like knowing where to buy your supplies, you need to think about where you will go for care if you need it.

If you have a primary care provider (PCP) — a doctor, nurse, or clinic you routinely go to — that should be your first phone call if you feel sick or fear you've been exposed. But 25% of Americans do not have a primary care provider, including 18% of women and almost half of millennials.

If you don't have a regular doctor, plan ahead so you know where to go if you get sick. If you have insurance, you may have an assigned primary care provider even if you don't know it. Call your health plan or check their online portal to see who they think your doctor is. If you don't like that provider, you can usually switch. In this moment, it may be good enough just to have any PCP to go to in case you need one.

If you don't have an assigned PCP, pick one from the health plan directory online. Call PCPs near you until you find one who is accepting new patients. Then, make sure the health plan has a record of who you want your doctor to be. Some insurers expect your PCP to be a gatekeeper and may penalize you if you don't start with them.

If you don't have insurance, look for a clinic in your area. Community health centers serve patients with and without insurance. If there's one near enough to you, call to see if they can treat you if needed. They may even be able to help you access free or subsidized health insurance.

2. Read and Understand Your Health Benefits

If you have insurance, figure out what it covers and what your costs could be — before you need care. Refresh yourself on the basics. For example, do you have a deductible? If so, how much is it and what services count toward it? Today, 82% of people with insurance through a job have a deductible; on average, people must pay the first $1,655 before insurance kicks in.

Some other questions to consider: What copayments do you pay for different types of services?

Are you subject to coinsurance, the percentage of medical bills you may have to pay? Has your health plan committed to waiving cost-sharing for COVID-19 testing? What about for treatment?

A lot of talk from public officials has made it seem like health insurers are waiving fees for any costs related to the pandemic; that is not true.

One analysis projects the average COVID-19 hospitalization could be more than $20,000. Time Magazine reported that an uninsured woman treated for COVID-19 got nearly $35,000 of medical bills. While many health insurers have committed to making coronavirus testing widely accessible, few have committed to waiving cost-sharing for treatment.

If you do get sick and need to visit the emergency room or to be hospitalized, you will likely have to pay your share of costs.

Many health plans are also relaxing rules for remote telehealth visits and to refill prescriptions. But your health plan costs will likely still apply if you do need care; it's best to know what those costs are ahead of time.

3. If You Do Need Care, Ask About The Costs

It may seem wrong to talk about costs when you're sick during a national emergency, but you may as well be prepared. Ask what the services you're getting will cost. Ask if you can get any help paying for care.

That said, if you're really sick, you may not have options. COVID-19 symptoms can be severe, and you may need intensive treatment that doesn't allow time to ask questions. A CDC analysis shows 12% of U.S. cases have resulted in hospitalization; of those, 24% required ICU stays.

Do not avoid potentially life-saving treatment because you're afraid of the costs. Get what you need and sort out the costs later. You can try to negotiate down the bills, seek assistance from public agencies or from the hospital itself. You may be able to get on a payment plan that makes it more feasible to pay off the bills. Government or nonprofit agencies might come through with assistance. Do not despair if you need to get care.

4. While You're Stuck at Home, Use Your Voice for Advocacy

While you can't participate in routine activities, take advantage of the flexibility to advocate for solutions.

Doctors and health care workers are urgently calling for a federal response to personal protective equipment (PPE) shortages. Sign on to their petitions. Follow the thread and if you're crafty, help make supplies. If in your early shopping rush you happened to snag a box of masks or gloves, come clean and deliver those to your local hospital or health center. They desperately need the supplies more than you do right now. Sharing your abundance will help protect your local doctors and nurses so they can stay well enough to keep caring for your community.

More broadly, call your elected officials — your governor, your U.S. representative, your U.S. senators — and demand that they mobilize responses to the crisis. Whether you focus on immediate or longer-term needs, every call helps apply pressure for them to act.

Demand that elected officials mobilize the federal response to PPE shortages. Ask for legislation that waives cost-sharing for coronavirus treatment — not just testing — and makes it easier for everyone to get mental health care, telehealth, and prescription medicines. Plead for direct economic relief for all citizens. From universities and scientific research labs to mom-and-pop stores and local restaurants, businesses across sectors need help to stay afloat. Funding can allow businesses to pay wages and insurance benefits during the crisis.

It's not hard to make a difference. When you call the office of each of your elected officials, state your name and where you're from and say you're calling to ask that the official take a stand on whatever issue you feel most passionately about that day. If you get voicemail, leave that message. If you get a person, read them your script. They'll thank you and be done. That's it. Do it every day or every few days. Encourage your friends to do it. Post the phone numbers to Facebook along with your script. People will appreciate your leadership and guidance on how they can contribute.

Feeling any sense of control during an unprecedented pandemic is difficult. By applying a shopper's mindset to your health care, you can be a little more prepared in the event you need to get care.

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