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Advocate for your patients through education on insurance plans
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Every year Gallup seeks public opinion on the honesty, ethics and trustworthiness of various professions within the U.S. They do so by randomly selecting landline/cellular telephone numbers and contacting more than 1,000 American adults. Respondents are “weighted” to accurately reflect the current demographics of the U.S. population older than 18 years of age.
The polling question is clear and simple: “Please tell me how you would rate the honesty and ethical standards of people in these different fields – very high, high, average, low or very low?”
Year after year the results are amazingly consistent, with health care providers such as nurses, pharmacists and physicians perennially ranked in the top five. Year after year, business executives, members of congress and lobbyists find themselves near the bottom of the rankings.
The validity and consistency of Gallup’s annual findings should come as no surprise. Most health professionals, optometrists included, gravitate toward this career sector largely because we take great pleasure in helping people stay healthy. Period. Our intent is validated on a daily basis – both through patient gratitude and in how they perceive us. It is a perception of educational commitment, strong work ethic and as a trusted advocate for their health and wellbeing. Our patients know we have their best interest front and center.
In this month’s “Professional judgment overrides insurance concerns” (pages 4 and 5), Dr. Charles Brownlow offers sage advice in dealing with an increasingly common and frustrating scenario, the one in which third-party payers deny reimbursement on prudent and medically necessary services, drugs and durable goods. It is a scenario that strains the doctor-patient relationship and challenges our efforts in providing quality care and being adequately compensated while maintaining a high level of honesty, ethics and trustworthiness in our patients’ eyes (no pun intended).
Personally, I have found some salvation in adhering to three simple dictums.
Patient needs always come first, yes, even if on occasion we fail to receive compensation – from either insurer or patient.
Perform only those procedures/tests and prescribe only those drugs/devices that truly benefit the patient. Yes, I know I am stating the obvious, but it is an exercise that requires us to continually challenge conventional wisdoms and improve efficacy and efficiency.
Educate, educate, educate. Granted, most providers do an exceptional job of explaining diagnoses, rationale for procedures and tests, and appropriate treatment options. However, many of us are not especially adept at educating on an equally important aspect of health care: the insurance plan. To better manage their health care, patients deserve to know exactly what they are getting for their premium dollar.
How do patients select a health care plan? They do this perhaps by asking a few questions of their employer’s human resources personnel or by talking with an insurance plan representative or even by visiting an online exchange site. This is not necessarily the best way of knowing whether you are getting a great plan – or one with limited coverage, poor benefits and suboptimal provider reimbursement.
As we move into a new era in U.S. health care, it is essential we advocate for our patients in every way possible, including their selection of health insurance and vision care plans. After all, it is our honest, ethical and trustworthy opinion they have come to expect.