How to Be a Savvy Medical Consumer

Taking the time to become an informed and proactive medical consumer is a simple matter of self-protection.

The need to be a savvy medical consumer is especially important if you are in a consumer-directed health plan, such as a medical savings account, because these plans place more responsibility for health care on your shoulders. But the benefits of being an active medical consumer include better health, more effective health care, and lower health costs.

Here are some tips for getting the best value for your health care dollar.

Your health plan

The more you know about your health plan, the better you can use it to your advantage. Here's how to do so:

• Get familiar with your benefits. Find out which services are covered and what limitations, exclusions, or lifetime maximums your plan lists. Choose a protection level that meets, but doesn't exceed, what you and your family need.

• Understand your financial obligations. Health plans typically ask you to pay a portion of the benefit costs, in the form of deductibles, co-payments, or flat fees. Use benefits wisely to save on out-of-pocket expenses.

• Know how to access your benefits. Follow your plan's guidelines for getting referrals to specialists, being admitted to a hospital, having an inpatient surgical procedure, getting a second opinion, having a screening test or exam, or using an out-of-network provider.

• Learn how to get help. You should know who to call to find out about benefits, ask billing questions, resolve a dispute, receive a referral, or get advice on health and prevention issues.

Your health care provider 

Your health care provider is your primary advocate within the health care system. Do your part by giving your provider all the information he or she needs to serve you better. You should also:

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

• Use self-care. Before you call the health care provider's office, you may want to consider calling a nurse advice line or use any similar option your health plan may offer.

• Prepare for an office visit. Be sure your health care provider has all the information needed to make an accurate 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.

• Research your condition and treatment options. You can find treatment information by reading books, contacting medical associations, such as the American Heart Association, and using the Internet.

• Explore less costly options. Ask if a generic medication is right for you.

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

Being an informed consumer takes time and patience, but the sense of power and the peace-of-mind it brings will make the effort worthwhile.