Dr. Thomas Mulligan Shares Insights on How To Get The Most from Your Healthcare Plan

Published on Thu, November 20, 2014
Dr. Thomas Mulligan Shares Insights on How To Get The Most from Your Healthcare Plan

For the next few weeks, many of us will have the opportunity to change our health insurance, which often changes our health care options.  Given the enormous changes to our healthcare system and the recent election, many are wondering how to get the best healthcare and insurance during these uncertain times.

As a patient with a life-threatening illness, I need the best healthcare.  As a physician with 34 years of experience in government hospitals, university hospitals and private not-for-profit hospitals as well as involvement in three managed care systems, I have reasonably good insights into how to get the best healthcare in our changing insurance environment. 

So, how do we get the best health care despite the tidal wave of change?

First, we need to realize that we cannot fight some changes.  Life gets easier when we embrace the change and try to make the best of it.  For example, unless we want to go bankrupt (personally and as a nation) we need to eliminate waste and strive for greater quality and efficiency in healthcare.  Tests, procedures and treatments that have no proven benefit should be abandoned, especially if they are expensive. 

Ask yourself the question, would I pay $20,000 out of my own pocket if this medical treatment was not likely to be of any benefit?  Likewise, why use expensive brand name drugs when generic equivalents are available?  Given this truth, it is not wise to choose our insurance coverage simply on the basis of who covers our current medications.  Rather, we need a physician who can select the ideal medications for us.

Second, now more than ever, we need a trusted and skilled physician who can help us navigate the challenges of getting good healthcare.  For example, should a 75-year-old man still get a colonoscopy every 10 years?  What is the most appropriate management for a 65-year-old man with high blood pressure, high cholesterol and heart disease?   How can we get the optimum medications without spending $500 per month?  If that 65-year-old man needs a bypass procedure, which hospital is likely to give him the best outcome?  Your physician should know the answers to these questions.  And, your insurance network should provide access to these physicians.

Third, we need to partner with our physician to be as healthy as possible.  For example, preventive strategies like mammography and colonoscopy really help certain patients.  Though we may find these tests to be unpleasant or even scary, we really should do them if we hope to stay healthy.  In addition to providing access to the best physicians, your insurance coverage should pay for tests that have been proven to be of value. 

When going to the doctor’s office, we should write down our questions ahead of time so that we don’t forget to ask those important questions.  One important question to ask is whether all my medications are still essential.  Not all medications need to be continued for life.  Another important question is whether a less expensive medication is available.  With rare exceptions, generic medications are just as good as brand name medications but much less expensive.  A third important piece of advice is never accept medication samples; instead, always ask if a generic alternative is available. 

Partnering with your doctor also means that though it can be difficult, we need to quit smoking, eat a healthier diet and exercise.  To help, many insurance plans offer free access to the Silver Sneakers program.   Why not avail yourself of these free resources?  They can only help.

Fourth, go to the emergency room only for real emergencies such as chest pain or sudden weakness on one side of the body.  Things like tooth aches and back aches only waste your time and everyone’s money when you go the emergency room rather than your doctor’s office.  Instead, call your doctor’s office and ask for advice if you are uncertain.  If you are on a Medicare Advantage plan, you likely have your own case manager who can guide you.  Helpful advice is only a phone call away. 

If your insurance coverage provides access to the best doctors and hospitals, pays for diagnostic/preventive tests with proven value, provides free access to Silver Sneakers and even gives you access to your own case manager, you are one of the fortunate ones.  These resources typically are available to people who choose Medicare Advantage plans.

Though the various insurance options have their pros and cons, whichever one provides the benefits mentioned above may be the best option for 2015 and the foreseeable future. 

If I can help, I would be happy to do so.

Your friend in the journey,

Tom Mulligan, MD

Medical Director, Senior Services, St. Bernards Healthcare

Clinical Professor of Aging, UAMS