Normally, a family’s medical care is handled by a primary care physician (PCP, also known as a general physician) who assists in diagnosis and prescribes a course of treatment for a wide variety of uncomplicated medical conditions. Specialists, on the other hand, have years of specialized training in a specific field, such as neurosurgery or nuclear medicine. Specialist care is typically significantly more expensive, both to health insurance companies and out-of-pocket costs to the consumer, so finding a specialist you’re comfortable with is essential.
First, familiarize yourself with your health insurance coverage. What sort of specialist care does your health insurance company offer? How much freedom do you have in choosing a specialist? That is, many health insurance companies charge different rates for in-network care (healthcare providers that the health insurance company has an established relationship with) and out-of-network care. Depending on your health insurance coverage, many specialists may be considered out-of-network care as well as being located a considerable distance from your home. Familiarize yourself with the literature available from your health insurance company and talk to your family doctor about the partnerships he or she has in the area. Patient advocates (people who specialize in learning about the healthcare industry) are also excellent sources for navigating health insurance claims and providing consultation. Given an accurate medical history, patient advocates can assist patients with finding affordable specialist care.
More important than repayment, however, is the certainty that the specialist in question is providing the right kind of care. Choosing a specialist hinges on an accurate diagnosis. Only then can specialists gather enough information to prescribe an effective course of treatment. An accurate diagnosis in turn depends on patients conveying truthful information to their primary care physician regarding their medical history. Physicians may ask uncomfortable questions, but they are attempting to assign and prioritize symptoms with a known condition. Before visiting your primary care physician, make note of any medications you may be taking, as well as any recent lifestyle changes (diet or movement included). Let them know about physical limitations, allergies (recent or historical), movement restrictions, pain levels, and recent changes in personal health. Accurate medical history information will allow your doctor to refer you to a specialist with much higher chances of finding an effective course of treatment the first time. This will give you the best chance at recovery while minimizing the expenses to your health insurance company. Since health insurance companies often mandate referrals to authorize specialist care, finding the right specialist the first time will keep costs from getting out of hand.
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