How to Be a Well-Informed Healthcare User

Learn how to work with your health plan

The more you know about your health plan, the better you can use it in your favor. 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 go beyond your needs.

• Understand your financial duties. Health plans often ask you to pay a part 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, solve a dispute, and get a referral.

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

Work better with your healthcare provider

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

• Find out how to use services. Can you ask your healthcare provider questions over the phone, or must you make an appointment? Can you get a prescription over the phone? Is there an online patient portal to communicate with your providers?

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

• Educate yourself. Becoming an informed healthcare user can help make sure you get safe, quality care.  To do so, learn more about any conditions and treatments you get by asking your healthcare provider for information for patients. Search reputable Internet sites, such as major hospitals or healthcare organizations or government sites. Talk with your healthcare provider about what you find.

• Follow through. When you commit to a treatment plan, take medicines as prescribed. Make sure you follow 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 healthcare provider has all the information they need. If you think of a detail you forgot to bring up during an appointment, jot it down. Then, call your healthcare 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 healthcare provider needs to know how you’ve reacted to medicines or treatments. This will help be sure you don’t get a medicine that may harm you.

• Ask your healthcare provider to write clearly. They 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. Be aware of possible side effects and when they should be reported

Mind your medicines

If you get prescription for medicine:

• Tell your healthcare 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 healthcare provider. Keeping your records up-to-date helps prevent dangerous interactions.

• Ask about generic medicine. When generic medicine 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 healthcare 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 healthcare provider’s suggestions. Keep asking questions until you know what you need to do. Being assertive and acting as your own healthcare advocate is the best way to get the best healthcare.