- Who's in charge when I need help and answers, but I can't get them?
- Who's in charge when I don't agree with my Doctor or my options?
- Who's in charge when I have a legitimate complaint that's being ignored?
- Who's in charge when I'm being billed incorrectly?
- Who's in charge when I get denied?
Who's in charge when I need help and answers, but can't get them?
First, I'd start at the source. Ask your Doctor. Tell him/her what it is that you need help or answers to? I've found most Doctors to be very intelligent, patient, and full of unexpected guidance when looking for answers. Remember, most Doctors have heard and seen just about everything. Plus, contrary to popular belief, they are human and do experience problems very similar to our own. If the Doctor doesn't have the answers themselves, I wouldn't be surprised if they at least didn't offer sound advice as to how to find the answers you seek. If not, keep your head up, there are several more places for answers, depending on the specific question. Let's assume that you need answers regarding specific medical treatment. Well, then your PCP should be a wealth of information, or they should have some idea about who would. Let's say they recommend that you consult with a Specialist. This is a good start, but don't get too overconfident. Specialists are like opinions, and believe me, they each have their own, unshakable opinion about what is and isn't the perfect thing for you! So, you meet with a Specialist, and they either give you the answers you want, or they add to the confusion, giving you more questions than answers. Shake it off and return to your PCP for another referral to a different Specialist. Explain why you felt that you and the Special you saw, seemed to have differing opinions, and you would prefer an alternate opinion before deciding what to do. Be determined. You are entitled to secondary opinions, especially when it involves any type of surgery or invasive treatment. You can also, while you're waiting to see this second Specialist, use the Internet to do some research. You should have formed some specific questions by now, after consulting with two different Doctors on the subject. Look for websites that are technical in terms about your specific situation or condition. But, also search for support groups having any relationship with your specific condition. These are average people from around the globe who have had or are dealing with the same problems you're facing. They sometimes can be your greatest resource guide. A lot of times, these people have stood exactly in your shoes, with lots of questions, and very few answers that aren't technical and unsympathetic toward your plight. These people understand that you not only need answers, you need reassurance that you're not alone. That there are others who've been where you are now and somehow they got though all of it.
Now while I strongly recommend listening to the advice and experiences of others, especially if they have or they are experiencing the same issues you're trying to deal with yourself. However, please use caution before wholeheartedly heeding someone else's advice, alone. This is the same as only looking at one side of a coin. There may be something vital and important on the other side. I would take the advice given as a starting point. Use their previous experiences and failures to guide you in the direction that's right for you, personally. This way, combined with your technical research, you can go see the second Specialist with a better understanding of what lies ahead. And, can now formulate questions of what's still bothering you.
If however, after all this, you are still unsure or can't get the answers you need. Then I would begin contacting other resources. For instance, maybe after all your research and talking with the Doctors, you've come to a conclusion on which treatment, etc., to pursue, however, you still have questions about where to go?, which Doctor to use?, how much will you have to payout of your own pocket?, Will you stay at the hospital or will this be outpatient care?, or What about after care and/or physical therapy?
These questions should be directed to the insurance company and/or the physician's group. Both phone numbers for customer care or service should be listed on the reverse side of your insurance card. If not, they PCP's office staff can find the phone numbers for you. Just ask.
When contacting either the insurance company and/or the physician's group, ask for customer service, or a benefit coordinator. Tell them you need a specialist for an explanation of your benefits. They should be able to answer all your questions or direct you to whomever can. Keep asking any and all questions until you are satisfied. Even if that means several calls over several days. It's better to know the answers up front, rather than be shocked with the bills arrive. Additionally, the Insurance company and/or Physician's group may require you to have certain tests and/or other treatments before you can proceed with surgeries or more expensive treatments, etc. They may also request recommendations from several Doctors and send you to see more Specialists for testing and opinions. Try to relax, and understand this is part of the process. However, don't allow yourself to be treated without care or concern for your condition or well being. If you are in pain and all the poking and prodding makes it worse, then demand to be given medication to help you cope and control your pain. If you feel no one is listening, then by all means stop them and make them listen.
If you still feel you're not being treated fairly or with respect or concern, then I would contact the local health care advocacy group. They are usually local by city or state and are part of a government run oversight. However, they do a lot of good. Generally, they are staffed by knowledgeable volunteers and others paid for their expertise. They can be a wealth of information and help. Just keep in mind, they are partly government run and therefore not always easy to get through to on the first few tries, and they do require lots of information from you before they'll proceed in assisting you. They may also have their own suggestions as to how to deal with your situation -- and I mean writing letters!, more specifically. So, call them, but be prepared for lots of advice, phone numbers, local support groups, other advocacy centers, addresses, etc.
Another place to contact, if you're truly still desperate for answers is the Dept. of Corporations, Health care division. They deal with HMO's, PPO's, and other health insurance groups. They take their time responding, and generally you'll be required to put your complaint or problem in writing from beginning to present.
Also, if you are covered by Medicare, or a Medicare provided insurance, then you can also contact them for general assistance, however, they will most likely refer you back to the Insurance company or Physician's group or another advocacy group. But, again they may have some helpful information.
In any case, asking questions can only be helpful. There are no stupid questions and every one's entitled to know the full story, especially when it pertains to your own body and the care of that body. You cannot make an informed decision or consent without being first fully informed to your own satisfaction. Do not allow the Doctors, the Insurance companies, etc., to bully you into making decisions without understanding why. While I realize some situations warrant urgency, I still believe you can be fully informed within a matter of minutes when one so chooses to do so. I've been in several urgent situations where I've had to make a choice with very little understanding. But, as I've also learned, if you continue to ask questions and voice your real concerns, most Doctors and staff do feel compelled to answer them as best they can. Unfortunately, only you can determine when you know enough to make an informed and educated choice. So, until you're there, stick to your guns and get those answers!