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Health Tips
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Research your Condition
Choosing the Right Doctor
Double Billing
Keep Costs Down - Tips
Make the Most of your Doctor Visit
Savvy Health Care Shopping
Choosing a doctor is one of the most important decisions you can make. You want to find a doctor with whom you feel comfortable, and who you think can give you the best medical care and advice. Here are some steps to take when choosing a doctor:
Research the doctor’s background and training
- Contact your health plan or look in your plan’s provider directory to find out whether or not your doctor has the Tier 1 designation, which designates that he or she is a high-quality, cost effective physician. Physician tiering applies to all employee and retiree non-Medicare GIC plans. You will save money with lower office visit co-pays when you see a Tier 1 physician.
- Learn as much as you can about the doctor’s background and training. A good place to go for information is the Massachusetts Board of Registration in Medicine’s website. Another source of information is WebMD’s physician directory , which provides hospital affiliation and lists other physicians in a particular doctor’s practice.
- Check other quality and care reports. An excellent source is the Massachusetts Health Quality Partners website .
Make sure the doctor is right for you
- Find out how long it takes to get an appointment. Make sure the doctor can see you without a long delay.
- Find out how you can reach the doctor after hours if you have an emergency. Ask if the doctor sets aside time for patients in need of urgent care—or makes arrangements with other physicians to cover his patients to make sure you are seen when needed.
- Ask who will be part of your health care team. Find out what other medical staff are available to see you (such as physician assistants or nurse practitioners), if the doctor is not available.
- Ask if the office is open in the evening or on weekends. Longer office hours may be more convenient for you.
- Find out what happens when the doctor is on vacation. Ask if there are other doctors who can see you if your doctor is away.
- Check to see if the doctor’s office is easy to get to. Find out if you can take public transportation. If you drive, ask about parking.
- Ask if you can use e-mail to contact the doctor. This can be a quick and easy way for you to ask questions or share any concerns.
Call the doctors’ offices that you think would be a good fit, and say you are interested in an initial visit. Use this appointment to ask questions and find out how well the doctor listens and whether you feel at ease with him or her. Having a doctor you respect professionally and feel comfortable with personally is good for your health. So take the time to make the right choice.
Information on “How to Choose the Right Doctor” is culled in part from information provided by the Partnership for Healthcare Excellence, a statewide initiative dedicated to helping Massachusetts consumers improve the quality of their own health care. The Group Insurance Commission is a member of the Partnership’s Leadership Council. Check out the Partnership’s website for additional helpful tools, tips and resources for patients, including how to prepare for medical appointments, take medications safely, prepare for surgery, and find resources and tools from trusted sources.
Taking Charge of Your Health: Research Your Condition
(summer 2006)
Patients who are actively involved in their medical care tend to have better outcomes. If you have been diagnosed with a particular disease, you may want to do research about your condition to find out about your disease, treatment options, and side effects. Armed with this knowledge, you can have more productive discussions with your health care team, and make the most of your doctor visits.
Check with your health plan to find out which physicians and hospitals have been rated as offering cost-effective, quality care.
The Internet offers a wealth of information, but much of it is unreliable. Make sure you find out who is maintaining the site. Sites funded by pharmaceutical companies may have helpful information, but be aware that the motivation for the site may be to sell their products. The following sources of information provide credible information to help you take charge of your health:
National Institutes of Health and Centers for Disease Control and Prevention websites provide useful and accurate health information, data and statistics.
Condition-specific organizations: These organizations produce consumer-oriented materials about the condition and sponsor patient support groups. Some renowned organizations include the American Cancer Society, American Lung Association, American Heart Association, American Diabetes Association, and National Multiple Sclerosis Society.
Leapfrog Group: This site compares hospitals on safety measures proven to reduce medical errors.
Your health plan’s website: Many GIC health plan websites now provide research tools for members. Most of these sites enable you to compare hospital treatment outcomes for specific diagnoses or procedures. The GIC website also includes a hospital comparison tool. Follow the instructions and enter the word “quality” as your password. Be aware that some of these commercial sites organize their evaluations differently from one another, so don’t be concerned if you get some differences in opinion.
U.S. Department of Health and Human Services Hospital Compare website: This site provides information on how well area hospitals care for their adult patients with certain medical conditions. Find out how often hospitals provided recommended treatments for heart attacks, heart failure, pneumonia, and surgery.
The Massachusetts Health Quality Partners website ) provides survey summaries on patients’ experiences with primary care physicians for over 400 Massachusetts doctors’ offices. Additionally, the site provides performance comparisons on providing preventive and chronic disease services for 150 Massachusetts medical groups.
The Commonwealth’s Health Care Quality and Cost website provides quality and cost data on Massachusetts hospitals for common conditions and procedures. It also lists the number of procedures that physicians perform. The site is continually updated to include the most current data available.
Avoid
Being Double-Billed for Co-Pays
(summer
2004)
Some hospital and physician group practices are billing GIC members for
office visit copays that the member already paid at the provider's office.
The GIC has become aware of these occurrences through members, staff experience,
and confirmation from our plans. Here is what you can do to protect yourself:
If you pay at the office, always get a receipt.
Always watch your medical bills. Keep your health plan EOBs (Explanation
of Benefits) and copay receipts in one place, and use this information
to cross-check bills you receive from providers.
If you are treated at a hospital-based physician office, consider waiting
until you receive the bill to pay for the office copay. Although many
doctors offices require copay payment when services are rendered, in general
hospital-based physician offices do not make this a requirement. (Copays
for surgery and inpatient hospital stays are usually not required on the
date of service, eliminating double billing issues.)
Find out the most effective way to resolve these discrepancies (e.g.
sending proof of payment by fax instead of mail) by calling the phone
number on the bill.
Tips
for Keeping Your Health Care Costs Down
(summer
2002)
Following
your Plan's rules and procedures will help to keep your out-of-pocket
costs down:
Get Referrals - If you are in a GIC HMO, call your Primary Care Physician (PCP) for necessary referrals
before seeing a specialist.
Ask your doctor for drug alternatives - bring your HMO or Express
Scripts (Indemnity and Navigator members) drug formulary list with you to
your doctor's visit to find the most appropriate, cost effective prescription.
Notify your Plan of emergency room visits and inpatient admission
- call them within 24 hours
Check your handbook to see if pre-authorization is required
- Commonwealth Indemnity Plan members need
to call before scheduling certain procedures or therapies, such as radiology
or physical therapy. HMO members - be sure to get a referral
from your PCP.
Before scheduling provider appointments, check with your Plan
to be sure the provider is a network member -- Commonwealth Indemnity Plan PLUS, Commonwealth Indemnity Plan Community Choice, Harvard Pilgrim Independence Plan and Navigator by Tufts Health Plan members pay higher out-of-pocket costs for non-network
services; HMO members usually cannot access out-of-network care except
in emergencies. Indemnity members -- see related out-of-state
coverage information.
If you have a covered student over age 19, keep your student
verification forms up to date.
Consider using your community hospital for routine care. Although
your out-of-pocket costs do not vary between hospitals, use of expensive,
teaching hospitals for non-tertiary care affects health care premiums
for everyone.
Living healthy also lowers your health care costs. Eat right, exercise
and don't smoke.
Making
the Most of Your Doctor Visit
(summer
2000)
Whether you are seeing a new doctor, or haven't seen your doctor in
a while, the following tips will help to ensure a productive visit.
Preparation and communication are key factors in enhancing health outcomes.
Bring a list including:
- All physicians and specialties you are seeing including mental,
dental, chiropractic, physical, alternative medical therapies, or
occupational health providers
- All prescribed and over-the-counter medications -- include dosage
and frequency of each
- Allergies including to medication and food
- Family medical history
- Past and present medical, psychiatric or psychological conditions
Communicate with your doctor:
- Any side effects of, or difficulties with, prescription drug medication
- If visiting because of an injury or pain, describe when and how
the incident or symptoms began. If you are in pain, describe the location
and whether it spreads to another region. Describe the quality of
the pain. For example, is it sharp, dull or throbbing. Describe the
pain's duration, what starts and alleviates or stops it, the time
of day or night it's most pronounced, or other patterns.
- If coming in with a digestive or urinary complaint, advise your
doctor of any changes in the frequency, consistency, or color of your
feces or urine.
- Other medical concerns and questions
- Sexual issues and questions
- Alcohol and tobacco consumption
- Exposures to environmental toxic substances
Savvy
Health Care Shopping
(fall 1999)
How did you choose your tailor or hairdresser? Chances are you selected
them because they ask questions, got to know your needs, and your style.
You probably stick with them because you like the outcome and feel you
are receiving a valuable service for your money.
Your health is paramount and you should shop for healthcare more diligently
than other services. A good health provider also asks questions, gets
to know you, and provides value for the state's and your money.
The National Center for Quality Assurance (NCQA) has devised measures
to assist consumers with shopping for healthcare, and for evaluating
HMOs specifically. One of their Year 2000 measurements pertains to cholesterol.
Does your current provider meet this recommended criterion?
Cholesterol Screening
- NCQA's Attribute of Good Care
Consumers over age 20 should have their cholesterol level screened.
Cholesterol is used to classify your risk for cardiovascular disease.
There are two types of cholesterol: High Density Lipoprotein (HDL),
and Low-Density Lipoprotein (LDL). Desirable HDL levels fall in the
60 mg/dl range. Desirable LDL levels are below 130 mg/dl. When levels
are above this level, your physician should begin regular monitoring,
or intervention measures, depending on the reading.
Pediatric
Preventive Health Guideline: Timely immunizations and screening
are vital for your child's health. The general guidelines for routine
exams and screenings are outlined on this GIC flier. Check with your
health plan to confirm what they recommend
and will cover.
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