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Pamela M. Peeke, MD, MPH

Pew Foundation Scholar in Nutrition and Metabolism
Assistant Clinical Professor of Medicine
University of Maryland
Baltimore, MD

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Navigating the Health Care System

Confused about how to get quality, affordable health insurance? Learn 8 tips for navigating the system

Women's Health Policy

No matter what happens with health reform over the next year, it isn't going to affect you and your family for quite some time. So you still need to be savvy about navigating the health care system to ensure you and yours get the best care possible at the best price. Here's what I've learned over the years from being on both sides of the issue.

Know your policy. Do not, repeat, do not, expect your doctor or his or her office staff to know what your policy covers, which hospitals or laboratories accept your insurance, etc. They are typically dealing with a dozen or more health plans, and it is impossible for them to be familiar with the benefits and networks of each.

Save everything—every communication from the insurance company, every bill from your doctor's office, every receipt for a co-pay or deductible payment. Insurance companies (and doctors' offices) make mistakes; in these economic times every dollar counts.

Evaluate the available plans during open enrollment time. Don't choose a plan just because your friend in accounting chose that plan. Think about what your family needs in terms of health care and how much you typically spend in a typical year. If you are fairly healthy and don't need much medical care, then a plan with a high deductible and low premium might be best; conversely, if you have a chronic condition that requires ongoing care, make sure you can afford the out-of-pocket costs.

Be your own health advocate. That means checking into the hospitals, labs and specialists to which you are referred rather than simply taking your doctor's work that they are good. It means questioning diagnoses or treatment recommendations if they don't sound right to you; making your doctor aware of any side effects or problems you have with the treatment; and following up on tests if you haven't heard back from your doctor's office. Primary care offices are overwhelmed with too many patients and too little time, and few are computerized. Tests can get lost.

Track your medical history. Until we have a national system of medical health records, you have to be your own medical health record. This is particularly important if you have a chronic condition like diabetes or cancer. Keep a running list of every doctor you've seen (including phone and address), every test ordered (and the results), every drug you've been given (and the side effects). Give a copy to every new doctor. Then when you tell your doctor you had a colonoscopy three years ago, you can also tell her who did it so she can get a copy of the results.

Take your medical records with you when you move. Give your doctor's office a week or so to get them together. Make a copy. Give one copy to your new doctor and keep one for your files.

Practice preventive medicine. The best way to navigate the health care system is to stay out of the system. That means staying as healthy as possible. And that means:

  • Scheduling screenings such as mammograms, colonoscopies, and Pap tests.
  • Following a healthy diet low in salt, sugar and saturated fat and high in fruits, vegetables, lean protein and whole grains.
  • Getting regular exercise. I'll settle for 30 minutes a day most days, but I'd be much happier if you upped that to an hour at least two or three times a week.
  • Washing your hands. There's simply no better way to prevent infection. Carry a little bottle of sanitizer in your purse, your car, your briefcase—and use it!
  • Take your medicine. The blood pressure pills, asthma inhaler and antidepressants aren't there to make you feel better immediately; they're there to keep your condition under control so it doesn't flare up and land you in the emergency department or hospital.

Communicate. Talk to your doctors, your nurses, and the office staff. Get to know them so they can get to know you. Be honest with them; if you don't tell your doctor that you drink vodka every night, she can't accurately diagnose that gnawing pain in your stomach. The linchpin of any relationship in the health care system is trust. If you don't have that with your health care professionals, it's time for a change.

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