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How to Navigate the U.S. Healthcare System When You Live with a Chronic Condition

Managing Migraine

June 28, 2022

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Ibai Acevedo/Stocksy United

Ibai Acevedo/Stocksy United

by Stefanie Remson

•••••

Meredith Goodwin, MD, FAAFP

Medically Reviewed

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•••••

by Stefanie Remson

•••••

Meredith Goodwin, MD, FAAFP

Medically Reviewed

•••••

•••••

Dealing with the U.S. healthcare system when you have a chronic condition can feel impossible, but it’s easier when you know what to expect.

The United States healthcare system can be frustrating, exhausting, and full of dead ends and rabbit holes. Having a chronic condition can make it even harder.

Plus, the COVID-19 pandemic has increased the burden on the already overwhelmed healthcare system.

Learning how to better navigate the healthcare system can not only save you time, money, and energy, but it can also help you feel more confident about your care.

People who are more active in their care journey usually report higher satisfaction. When people feel involved in their care plan, they’re happier with the care they receive.

In fact, a 2006 study found a need for a more flexible and patient-centered care model. In a patient-centered care model (PCC), patients can decide which services they need and how these services should be delivered. It gives people more say in their healthcare plan.

So what can you do to make navigating the system a little easier? Here are a few pieces of advice I’ve learned both as a patient and as a healthcare professional.

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Stay in-network

Find a professional that’s contracted with your insurance plan. Start by calling your insurance and asking for a list of contracted providers, someone who’s in-network with your insurance plan.

After you get a list, call some providers to ask if they are taking new patients. It also doesn’t hurt to ask friends, family, and peers if they recommend any of the doctors on the list.

Going through these steps can help narrow down a long list of possible providers into a more manageable selection of good options.

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Opt for telehealth

Check for convenient telehealth and remote visit options. Even if the copay is the same, you may save on missed work, childcare, and transportation costs.

However, telehealth appointments might not be suitable for some situations, like emergencies and anything requiring a physical exam.

Don’t let wait times deter you

Wait times to see specialists, and in some places, even a primary care professional, can be long. In my opinion, the best thing you can do is book the first available appointment, even if it’s 3 months away.

Typically, it’s a lot easier for an office to move up an appointment to a different date than create one from scratch. You can also call the office every day to ask about cancellations or new availability.

Another suggestion is to go to the office in person and ask if there are appointments available for the same day. Often there are cancellations and changes in healthcare schedules.

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Schedule strategically

Sometimes, getting something done is a matter of how you approach it.

Can’t get through to anyone to make an appointment or ask a question? Try to call at different times of the day. I also try to avoid calling during traditional lunch hours.

Go in person and ask to speak directly with someone about your particular concern. Ask who the right person is for your particular question or concern. If there’s someone specific you need to speak with, ask for their direct line.

Also ask if the service you’re inquiring about, like billing, is on-site or off-site.

Complete your paperwork early

Whenever possible, complete the registration paperwork ahead of time. Most places offer it online or will give it to you early if you stop by the office. Some places have paperwork posted on their website or will even email it to you directly.

Email any relevant health records, or drop them off in person. Scanning documents into the electronic health system can take a while, and it can be helpful to add extra time for this process before your appointment.

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Understand you won’t click with every doctor

Every person’s experience with a provider is different. Just because someone else had a good experience with an office or a doctor, it does not guarantee it will be a great fit for you. Everyone has different needs, personalities, and priorities to consider.

Don’t be afraid to find a different professional if you don’t love the one you’re seeing.

Bring support

It can help to have an extra set of eyes and ears at your appointments. Your spouse, friend, or family member might think of different questions to ask your professional.

Most importantly, always bring someone if you’re having a procedure of any kind. You really never know how you’re going to feel afterward.

A patient advocate can also be a great resource for you. Advocates who are provided and employed by the hospital may not always have your best interest at heart. Hiring your own patient advocate can help you navigate all the hurdles of the U.S. healthcare system, can attend doctor visits with you, and will explain billing or help you contest something if you disagree.

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Take notes and keep track

Sometimes, we need time to process and recollect our thoughts before asking questions. But, if you want to use video or audio recording during your visit, you need to ask permission from the office and provider first.

Immunization records are also important to have. Keep a copy of yours handy. You can even register with the state vaccination tracking system provided by the Centers for Disease Control and Prevention (CDC) for easy access and verification.

Save money on medications

While you’re already calling your health insurance for the above list of providers, ask them for their prescription formulary.

The prescription formulary is a list explaining exactly which medications are covered by your insurance and what tier they are. Usually, there are three to four tiers of medication. The tier signifies how much they’ll cost you out of pocket. Tier 1 is typically the cheapest.

Bring the prescription list with you to your appointments. Check the medications your doctor prescribes against this list prior to leaving your appointment.

You can also give this list to your medical professional or pharmacy to help with the prescribing process.

If your medications aren’t covered or are still too expensive:

  • Ask the office to do a prior authorization application for you. This cost-control plan can help reduce the cost of medications.
  • Contact the drug manufacturer directly to ask about assistance programs for medications. Often, these are lengthy and time-consuming applications, but they are usually good for a year.
  • Ask your pharmacist or pharmacy staff for help. Sometimes, they know about programs, applications, or coupons. This is especially true for smaller and specialty pharmacies.
  • Check the App Store on your smartphone or tablet for helpful apps. GoodRX.com is a great web resource and free app that compares medication prices and provides coupons.
  • Check your local support groups and social media pages. Sometimes, there are very specific programs for conditions, medication combinations, or geographic locations.
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The bottom line

Spending a little more time doing paperwork, researching the best specialist for you, and finding deals on medications, can help make navigating the U.S. healthcare system a lot less stressful.

Small changes can help you better manage your time and help you feel in control of your care plan.

Navigating the U.S. healthcare system can be a challenge, especially when you live with a chronic condition. It’s easier when you know what to expect.

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About the author

Stefanie Remson

Ms. Stefanie Remson MSN, APRN, FNP-BC is the CEO and founder of RheumatoidArthritisCoach.com. She is a family nurse practitioner and is a rheumatoid arthritis (RA) patient herself. She has spent her entire life serving the community as a healthcare professional and has refused to let RA slow her down. She has worked with The Arthritis Foundation, The Lupus Foundation of America, Healthline, Grace and Able, Arthritis Life, Musculo, Aila, and HopeX. You can learn more at her website and on Instagram, Facebook, and Pinterest.

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