The Empowered Patient: 2014

/SPECIAL FOR THE AJT/ DR. JASON REINGOLD, MD

Like it or not, 2014 ushers in some of the key features of the Affordable Care Act.

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Whether through a direct piece of legislation or as an unintended consequence, the Affordable Care Act has and will continue to change the landscape of healthcare – and Atlanta is an epicenter of change.

My wife and I learned certain lessons the hard way over the past few months (yes, even doctors are confused about healthcare reform and insurance) so hopefully you can learn from our mistakes.

Here are four tips on how to become an empowered patient to survive this “Brave New World of Healthcare.”
Understand the fine details of your healthcare plan:
ACA approved Insurance plans will have higher out of pocket expenses and more restrictions so it is more important than ever to understand your plan. Do you have to obtain referrals and pre-authorizations? Are you eligible for discounted premium rates by completing biometric screenings or health maintenance classes? Who is in your network and what happens if you go out of network? Most importantly, verify your benefits before each visit and review every bill with your insurance company.
Find out whom your doctors work for and what this may cost you:

Experts expect hospitals in major cities like Atlanta to purchase more primary care and specialty in 2014.  So how does this affect you? As reported in the New York Times (6/14/2013), “In many cases, a physician’s practice that is purchased by a hospital stays in the same location and treats the same patients but beneficiaries pay more for the same services.” While state and federal policymakers debate this complicated issue, advocacy groups recommend patients get informed on costs when utilizing a hospital-based physician or service even if done in the office setting.
Shop around and ask for discounted self pay rates:
More and more independent practices and even hospitals are offering significantly discounted rates on office visits, lab tests, imaging studies, and even procedures when paid in up front. Some of these can be found on practice websites or online consumer healthcare websites like healthgate.com, but I recommend directly asking your doctor. This is especially important for patients with high deductable plans. Just be sure to find out your insurance company’s policy on self pay and then get proper documentation to count any out of pocket expenses towards your deductable. Do this before insurance is billed or it’s too late.

Maximize your insurance plan’s freebies:

The Affordable Care Act requires insurance companies to provide services to enhance the health of Americans from newborns to seniors. Whether you agree with this or not, be sure to take advantage of eligible programs since you are paying for them either way. I was amazed when my pregnant wife’s free breast pump actually arrived. Seniors on Medicare are eligible for some of the most extensive perks. Yet, experts note that only 7 percent of them have taken advantage of these free programs.

In conclusion, only the empowered patient can survive this “Brave New World of Healthcare.” Remember, doctors are often as confused and upset as you are.

Dr. Jason Reingold is a Harvard trained, nationally recognized, board certified cardiovascular disease specialist.  He offers personalized and cutting edge cardiovascular care with a focus on prevention to patients throughout the Southeast at Atlanta Cardiology and Primary Care, PC.  Contact him at drjasonreingold.com and follow him on Facebook.        

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