Have you ever really thought about why it’s such a challenge navigating your own healthcare? I don’t know about you, but I swear up until I cracked the code, I felt like I spent my days at the Department of Motor Vehicles when I went to the doctor. Yeah. I made that correlation, and you know I’m right about it. The healthcare system is just another bureaucracy here in the U.S. and every other country as well when you get down to the dirty details. The problem is as consumers, I don’t think we really understand it’s a bureaucracy. Why? As consumers we think of bureaucracy as part of the government, but the reality is the bureaucracy can be part of any business or process that provide services. And as consumers, it’s frustrating as hell.
Think about the last time you went to the DMV to get your license renewed or update your license tags for your vehicle. IT TOOK ALL DAY. You arrived at 7 am to stand in line outside waiting for the DMV to open so you could take a number to conduct your business. Maybe there were 3 or 4 customer service representatives to serve you and 150 of your closest friends who stood in line with you. Each transaction took between 15 to 30 minutes depending on the services the customers ahead of you needed. By the time you took care of your business, you wasted at least half the day, if not more.
Does any of this sound familiar? Wait didn’t that just happen to me the other day at the VA Medical Center at Kaiser? At the OB’s office for your 32-week check up? The healthcare system is a bureaucracy. But the bureaucracy isn’t just on the side of getting in for an appointment and being seen by your doctor.
In the Doctors & Insurance Bootcamp, I talked about how doctors get paid. The Relative Value Scale Update Committee (RUC), which is an expert panel, assigns value ratings to the work a physician does based on the specific procedure performed, and that value rating is converted into a monetary cost. Medicare either accepts or declines the rating/cost for the service. Health insurance companies base their payments to physicians on these fees. Basically, what your insurance plan pays out to your doctor or covers for labs is just another layer of bureaucracy within the healthcare system. This is just one aspect of how healthcare is a bureaucracy.
Have you ever sat down to read your insurance plan? I have, and there are times I think figuring out how to do taxes using a 1040 long form is easier to understand. As a consumer, sometimes it’s hard to get an actual copy of your plan. I’ve spoken with people who have insurance through the Federal Government, and they can’t even get a downloadable PDF of their plans. These individuals not only deal with the health insurance company’s bureaucracy, but they have to work through the government bureaucracy as well!
Now that you’ve begun to digest that the healthcare system is just another bureaucracy, the processes behind it might make a little more sense. Now I treat the healthcare system as I would any other bureaucracy.
What are the key things you need to consider when navigating a bureaucracy?
Things do not happen quickly in a bureaucracy. It takes time to find the right doctor to help you on your journey. You may actually need to build a team of doctors and teach them how to work together on your medical issues. It can take time to build your relationship with your doctor. It may take up to six months to see a specialist, depending on where you live and who your insurer is.
It takes time to find the correct person to talk to or correspond with regarding services when dealing with health insurance companies. It takes time to appeal denied claims. Sometimes it feels like all you’re doing is wasting time when you’re navigating the healthcare bureaucracy, and it’s frustrating.
I found that getting something in writing from the insurance company when something is or is not covered went a lot further than just a phone call. Documentation is your backup, your justification for a procedure. It could be your requirement for services, your ICD codes, a letter of medical necessity, a medical evaluation, your lab work results, etc. Document everything, including everything you pay out of pocket, because if you spend 10% of your salary on medical expenses, you can use that as a deduction on your taxes.
The definition of tenacity is “not easily stopped or pulled apart; very determined to do something.” When dealing with any bureaucracy, especially one like the healthcare system, you’ve got to be prepared to go the long haul. You’ve got to also understand you will hear the following words more than you can count: No. Can’t. Won’t. Doesn’t. Take these negative responses and make them work for you by limiting their power over your situation. These are unacceptable responses. You’re paying for services from your doctor and from your health insurance company. Hold them accountable for those services. What’s frustrating is as a customer you have to fight to receive the services you pay for through premiums, copays and coinsurance.
You need patience on this journey. The reality is when you’re on the phone with customer service trying to understand the background for a denied claim, you’ll have more success if you’re patient. The call centers are used to irate people calling up demanding an explanation. You’ll be that breath of fresh air when you call inquiring about your denied claim. You might discover that in just being patient with the person on the other end, they might actually help you and give you the keys to solving your denied claim. Remember that old saying you’ll catch more flies with honey that excrement? It’s true. Apply it when you’re trying to get help figuring out what happened with your denied claim. Patience will help you navigate the healthcare bureaucracy just like it helps you navigate the DMV.
If you’d like learn more on how to navigate the healthcare bureaucracy, I’ve set up several e-courses that will help you make the most of your journey to optimal.
Do you have any other tips or tricks you’ve found useful when dealing with healthcare? Share your advice in the comments section!
About Gretchen’s Epi-Paleo Tenacity
Who am I and why Your Paleo Healthcare? Hello, for those of you who don’t know me, I’m Gretchen Bronson. I’ve been on a journey through the healthcare system for the past 13 years. Like many of you reading, I found myself discouraged by the inability of the current medical system to help me solve my medical problems. I’ve had migraines and asthma for more than 30 years, and after leaving the Air Force, I’ve been battling weight issues. To top it all off, the Veteran’s Administration diagnosed me with fibromyalgia, Chronic Fatigue Syndrome, Polycystic Ovary Syndrome (PCOS) and bipolar disorder.
In 2004, I began to take ownership of my healthcare by searching out doctors who could assist me and help me leverage the health insurance I had. The biggest thing I’ve learned on this journey is how to leverage my health insurance to my benefit. I’ve figure out how to get labwork covered 100 percent, in addition to all medical treatments. I’ve also cracked the code for successfully appealing medical claims.
On this journey, I’ve seen improvement in my health in small increments. The first improvement came in 2004 when my VA Medical Center neurologist sent me to a local chiropractor and recommended I go gluten-free. Just with the change of going gluten-free, I saw my migraines decrease from 6-8 events per month down to 4-5 per month. I’ve had migraines since the age of 10, and I had learned to live and function with them, but having the frequency drop just by eliminating a specific food was an epiphany for me. I realized at this point how important food is for overall health and wellness.
Then next phase of my journey began when I found Mark’s Daily Apple. I bought Mark’s book the Primal Blueprint, and I took a primal leap. Going 100 percent grain-free was easy. The hard part was kicking the sugar from my diet. I was addicted to sugar. It took me almost four months to completely kick sugar to the curb. Once I did, I saw improvements, and by February 2011, I was out of maternity clothes and in size 12 pants. For the first time in my life, weight loss seemed to be easy. But then I stalled out in my weight loss and became frustrated.
After trying everything under the sun to help me continue losing weight, I found Dr Jack Kruse’s Leptin Reset. Not only did I follow the reset, I began voraciously reading every word Jack blogged. It all made sense for me. So I embraced it, and things started happening. My energy changed, my perspective changed, I felt healthier. Some of Jack’s ideas were crazy and out there, sure, but nothing else was working with regards to my health, so I gave crazy a try, and it’s working! I’m seeing health improvements, and I’m uncovering the biggest impacts to what’s going on in my health the health of my family.
During this time, I was also able to find a primary care physician who embraced the paleo lifestyle and had a five-star rating for treating familial hypercholesterolemia from my health insurance. I also found an anti-aging doctor, Dr. Dzugan, who has a proven track record using bio-identical hormones to help control and eventually eliminate migraines! Suddenly things all started coming together. I started making great gains with my health, and I was able to leverage my health insurance to cover at least 85 percent of my medical expenses.
I’m going to share with you as I continue on my journey the things I’ve learned that helped me leverage my health insurance and launch the recovery of my health. I look forward to showing the things that I’ve learned and hope you’ll be able to take my experiences and apply them on your own journey to health and wellness.
More Support: Webinars by Dr. Kruse
|For this bootcamp, we are going to give you a foundational education on how to find a doctor, work with insurance companies, get your labs paid for and advocate for your own coverage. We’ve aggregated a wealth of resources, templates, scripts and more that we’re going to share with you to make it as easy as possible for you to find the help you need in the western healthcare system. Buy the Doctors and Health Insurance Bootcamp now!|