How to Beat the Health Care System

uest article by Joshua Bub, DVM, DABVP

If your first thought after reading the title to this article is “Why would I need to beat the health care system?”, I understand where you are coming from, because I thought the same way early last year.  I was relatively healthy, had great (relatively speaking) employer sponsored health insurance, and had only experienced a few minor issues with the system over the course of my adult life.  I knew our health care system wasn’t perfect, but I was naïve to just how bad it can be.

Unfortunately, I fell ill last year and got first hand experience with many of the issues patients face with modern health care.  That indirectly led my wife and I to open Pure Family Medicine to try and improve health care for her patients.  These experiences have made me wise to the tricks and intricacies of the system, and today I’m going to share the ways you can take charge of your health care, make your way through this messed up system, and hopefully come out on top!

Find a great primary care physician

If you read one thing in this article, make it this.  Prior to getting sick, I religiously saw my primary care doctor yearly, and so when I got sick my PCP knew me and saw me immediately.  She quickly started a focused but thorough diagnostic workup and sent me to the appropriate specialist only when my workup went beyond the scope of primary care.  A great primary care physician…

• Can care for 90% of your health needs (when they have the time) and in many cases can save you unnecessary referrals to specialists.
• Can streamline diagnostic workups to save you time, money, and unnecessary testing since they are trained to look at the big picture, rather than one individual organ system.
• Will be your advocate as you navigate the health care system, helping you get what you need in a timely fashion, and helping coordinate your care with and between specialists (incredibly important!)
• Will give you personalized advice to help you stay healthy and detect disease early in its course thus improving your chances at beating it.

If I had a lackluster PCP, or worse, relied on urgent care I could still be in the system getting worked up…

Be your own advocate

(or have a great PCP who will advocate for you)

Doctors are busy, that’s how the system is, and I’m sympathetic to both patients and doctors who have to deal with the consequences of that.  As a result, you will not always get the time or attention you need, and your physicians may miss things that are potentially important.  Know your health history, know your medication list (and if you have the training, what the potential side effects and interactions are), and if you have a health condition please do your research and know it like the back of your hand.  Your thoughts, opinions, and knowledge are important and they may save your life.  I am a veterinarian by training and so my medical knowledge makes it easier for me to advocate for myself.  If you are not in a position to be your own advocate, find a medically trained friend or relative who will be, or find a great PCP who will have your back!  While we’re discussing this, make sure you are using evidence based and medically reputable sources for your medical research, there is a LOT of misinformation out there.

Urgent care and ERs are not for routine care or complex workups

Emergency rooms are for potentially life threatening emergencies.  Urgent care centers are for urgent issues that can’t wait until your doctor’s office is open.  The doctors and mid-level providers who staff these facilities are trained to stabilize and treat you, and they are amazing at doing this.  Many are brilliant diagnosticians and some of the best doctors you will ever encounter, but you should not rely on them in lieu of a PCP or another specialist.  If I didn’t know better, I would have had my gallbladder inappropriately removed based on advice I received after an ER visit.  Your medical care should be entrusted to a team of physicians who communicate with each other and are able to look at the big picture when needed.

If you use insurance, double check EVERYTHING

I consider myself wise to the intricacies of the insurance system.  I made sure my specialists were in network, I made sure my diagnostic facilities were in network, I made sure my hospital was in network.  I failed to double check that my hospital’s diagnostic lab was in network, and so got an $1800 bill for a $40 test (I fought tooth and nail and eventually got this covered).  You even need to check that the doctors you are seeing in the hospital are in network.  Yep, even if your hospital is in network, make sure every physician who rotates through your care accepts your insurance, make sure every surgeon and anesthesiologist who cares for you accepts your insurance, and make sure all the labs used for your testing are in network (To be clear, it is not the fault of the physician who is working in the hospital if they are out of network, these things are usually beyond their control).  This process is exhausting, but if you don’t double check, your medical expenses could bankrupt you.  Ironic that can happen to you even after you pay $20,000 a year for insurance.  There’s a better way though…

Ask for cash pricing

This blew my mind when I first started researching Direct Primary Care.  Without going into details too much, with my excellent employer subsidized Gold-tier equivalent health insurance, I saved only $1000 throughout my journey through the medical system versus if I had planned ahead and sought out the best cash pricing for my workup.  That insurance costs $22,000 on the open market to save $1000.  It’s insane.  If I had been part of a Direct Primary Care practice, I probably would have come out ahead.  More on that later.

So how do you get cash based pricing in an insurance based system?

• If possible, plan your medical procedures and testing ahead of time.  Call different facilities and ask for their up front cash pricing.  Sometimes that’s enough.
• If you want to keep your medical records private, you can insist on cash pricing with HITECH.  HITECH is a federal law mandating health care providers and hospitals provide you a cash price if you ask for it for privacy reasons.  You have the right keep your medical records private from third parties by paying cash.  If you’d like to learn more, you can find information here
• A Direct Primary Care practice will have a network of specialists, diagnostic facilities, and imaging centers that offer competitive cash pricing.  They will also typically give you access to inexpensive medications.
• Use sites like GoodRx or Blink Health to get reasonably priced medication.
• If you are in an emergency situation and don’t have the time or cognizance to ask for cash pricing, you still have options.  You can ask for Medicare rates, you can ask for privacy and cash pricing with HITECH, or if you are a member of a Health Share they will typically negotiate on your behalf.  If you encounter issues, or get an outrageous bill, you still have options so don’t give up.  DPC Frontier has fantastic resources that will give you more info.

Look into health sharing

Everyone needs health coverage of some sort, there are truly catastrophic things that can happen that can bankrupt even the most savvy medical consumer.  But there are alternatives to insurance.  Medical health sharing has proven to be a great option for some people and it at least warrants a look as the monthly contributions are typically half that of health insurance plans.

Join a Direct Primary Care practice

I know you were waiting for the sales pitch, and here it is.  Hopefully from reading this article you can see why I truly believe in the benefits of joining a Direct Primary Care practice, after all it was my experience in the medical system that led my wife to open Pure Family Medicine.  Members in a DPC practice get:

• A primary care doctor who knows them, who has the time to address all their medical needs, and who will be their advocate if they need to journey into the health care system.
•  Enhanced access to their physician to avoid some ER and urgent care visits, and at least get personalized advice if there is an after hours emergency.
• Access to heavily discounted cash based pricing for labs, medications, and diagnostic imaging, and DPC docs typically have a network of specialists they trust who will give you an appropriate cash price for their services.

Regardless of what type of practice you are with, I hope my health care experiences and the tips I shared will help prevent some frustration, financial mistakes, and poor health outcomes for you and your loved ones.  And at the very least, if you don’t have a primary care doctor, find one today!