Health Encyclopedia

How to Be a Savvy Medical Consumer

Taking the time to become a savvy medical consumer is a matter of self-protection. The benefits of being an active medical consumer include better health, more effective health care, and lower health costs. It takes time and patience, but the peace of mind is worth it. Here are some tips for getting the best value for your health care dollar.

Learn how to work with your health plan

The more you know about your health plan, the better you can use it to your advantage. Make sure to:

  • Get to know your benefits. Find out which services are covered. Learn the limits, exclusions, or maximums of your plan. Choose a coverage level that meets, but doesn't exceed, your needs.

  • Understand your financial duties. Health plans often ask you to pay a portion of the benefit costs. These come in the form of deductibles, copayments, or flat fees. Use benefits wisely to save on out-of-pocket costs.

  • Know how to access your benefits. Follow your plan's rules for referrals to specialists, being admitted to a hospital, having surgery, or using an out-of-network provider.

  • Learn how to get help. Know who to call to find out about benefits, ask billing questions, resolve a dispute, and receive a referral.

  • Use self-care services. Before planning an office visit, see if your plan has a nurse advice line or similar service.

Work better with your health care provider 

Your health care provider is your main advocate within the health care system. You should:

  • Find out how to use services. Can you ask your health care provider  questions over the phone, or must you make an appointment? Can you get a prescription over the phone?

  • Prepare for an office visit. Be sure your health care provider has all the information needed to make a diagnosis. This includes your medical records, family medical history, and a list of the medications you take. Bring along a list of questions and issues you want to discuss.

  • Educate yourself. Becoming an informed health care consumer can help ensure the safety and quality of your care. To do so, learn more about any conditions and treatments you receive by asking your health care provider for pamphlets and brochures. Search the Internet and discuss what you find online with your health care provider.

  • Follow through. When you commit to a treatment plan, take medications as prescribed. Make sure you comply with all disease-management and prevention steps.

Make the most of appointments

An office visit is also an opportunity. Make the most of it by:

  • Starting with open communication. Don’t assume your health care provider has all the information he or she needs. If you think of a detail you forgot to mention during an appointment, jot it down. Then, call your health care provider or nurse.

  • Asking questions. Be sure to get a clear explanation of your care and ask about treatment, results, and any possible side effects. Write down what your need to know about treatment; don’t trust your memory. And remember, it’s your right to get a second opinion if you want one.

  • Sharing any history of allergies or reactions. Your provider needs to know how you’ve reacted to medicines or treatments.This will help ensure you don’t receive a medication that may harm you.

  • Ask your health care provider to write clearly. He or she should clearly write the name and purpose of a prescribed medicine, as well as instructions for taking it. Then check to make sure the pharmacist gives you the right one.

Mind your medications

If you get prescription for medication:

  • Tell your provider what medicines you take. This includes over-the-counter remedies and supplements—how much you take and when you take them. Review your medicines at least once a year with your health care provider. Keeping your records up-to-date helps prevent dangerous interactions.

  • Ask about generic medication. When generic medication is available, it can cost much less.

  • Follow directions. Taking too much or too little medicine or using the wrong one is the most common medical error.

Keep on top of preventive care

Talk with your health care provider about:

  • Screenings for cancer, heart disease, diabetes, and other problems

  • Immunizations for illnesses

  • Counseling for mental health concerns

  • Your diet and activity levels

  • Your weight

  • Stress management

  • Smoking or substance abuse

  • Steps you can take to prevent chronic disease

It’s up to you to follow your health care provider’s suggestions. Keep asking questions until you know what you need to do. Being assertive and acting as your own health care advocate is the best way to get optimum health care.

Medical Reviewers:

  • Fincannon, Joy, RN, MN
  • Hanrahan, Maura, MD