Navigating the Healthcare Maze

Welcome to Navigating the Healthcare Maze. You’re watching part 1 of this 5-part video series.

In these videos, you will learn about the different types of insurance coverage, where to receive care, and how to understand your medical bills so that you can take control of your health.

The healthcare system includes 3 main components:

• Patients
• Providers
• Insurance

First off, there's you - the patient. We want you to be able to make well-informed decisions, but healthcare can be confusing, so the more you understand the better.

Next we have Providers. When you hear the term PROVIDER, keep in mind that it doesn’t always refer to a doctor. It’s any person or place providing healthcare services which could be a doctor, a nurse practitioner, a physician assistant, a pharmacist, a hospital, or an urgent care center.

Lastly, you’ll learn about Insurance. As a consumer there are various ways to obtain insurance:

You can buy healthcare insurance directly through a private company.

Your employer may offer health insurance as a benefit.

Some people choose coverage through the Affordable Care Act (ACA) exchange, known to California residents as Covered California.

Those who qualify may receive Public Health insurance coverage such as Medicare and Medicaid, known as Medi-Cal in California.

Or if you do not have insurance you may choose to pay cash for healthcare services.

In these next 4 videos, we will dive in deeper to help you better understand each of these concepts and give you the knowledge you need to navigate the healthcare system.

We recommend you watch them in order, but if there is a particular topic that interests you, feel free to jump to that video and start there.

To view the rest of the videos in the 5-part series and to discover additional resources and tools visit PIHHealth.org/Resources

Be sure to “Like” this video if you found it helpful and follow us on Facebook, Instagram and Twitter @PIHHealth

Welcome to Navigating the Healthcare Maze. You’re watching part 2 of this 5-part video series. In these videos, you will learn about the different types of insurance coverage, where to receive care, and how to understand your medical bills so that you can take control of your health.

In this video, we will cover the different types of care and the roles of each member of your healthcare team.

Primary care is your first point of care for annual physicals, preventative care like vaccinations, and diagnosis and treatment of common medical conditions. You may see a Doctor, Physician Assistant, or Nurse Practitioner.

Specialty care is provided by doctors who are trained to treat specific diseases or injuries. For example, if you have diabetes you may need to see an Endocrinologist. Or, someone with a knee injury might see an orthopedic surgeon.

When something unexpected happens, you may need urgent or emergency care.

Urgent Care Centers are staffed by specially trained doctors to treat illnesses or injuries that are NOT life threatening but require quick attention. This includes minor cuts and burns, broken bones, ear pain, or sore throat. Your cost for an urgent care center may be far less than an Emergency Room.

Emergency Rooms are for life-threatening symptoms such as chest pain, difficulty breathing, stroke and serious injuries. For life threatening emergencies call 911 or go to the nearest emergency room.

If necessary, you may need to be admitted to a hospital.

It is important to understand which urgent care centers and hospitals are covered before choosing your insurance plan.

Home health care may follow a hospital stay. This includes a wide range of services that can be provided in your home by nurses or therapists who visit on a regular basis. Examples include wound care, physical or speech therapy, and monitoring of serious illnesses.

Long term care is for those who need help with everyday activities like eating, bathing or getting dressed. Long Term Care can be provided in a person's home, rehab center or an assisted living facility. This type of specialized care often requires separate health insurance coverage.

The last type of healthcare we’ll be covering is hospice, or end of life care. If you or a loved one is near the end of a terminal illness, hospice care maintains quality of life comfortably and also provides emotional, social and spiritual support. Hospice care can be provided in your home or in a dedicated facility.

So now you should know more about the various types of healthcare, and who may be part of your healthcare team.

To view the rest of the videos in the 5-part series and to discover additional resources and tools visit www.PIHHealth.org/Resources

Be sure to “Like” this video if you found it helpful and follow us on Facebook, Instagram and Twitter @PIHHealth

Welcome to Navigating the Healthcare Maze. You’re watching part 3 of this 5-part video series.

In these videos, you will learn about the different types of insurance coverage, where to receive care, and how to understand your medical bills so that you can take control of your health.

In this video, you’ll learn about the different types of health insurance available in the United States. One of the most important things you can do for your family is to understand how to choose the right health insurance plan.

There are several options for healthcare coverage. You may be offered health insurance through your employer. Or, you may purchase private insurance on your own or through the Affordable Care Act Exchange, known in California as Covered California. Or, you may qualify for a government program such as Medicare, Medicaid or the Veterans Administration.

When choosing an insurance plan it is important to understand the 3 main types:

• Health Maintenance Organization or HMO,
• Preferred Provider Organization or PPO,
• and Point of Service or POS.

With an HMO you select a medical group and primary care doctor who manages all of your care. A referral from your primary care physician is required to see a specialist

HMO plans tend to have lower premiums and deductibles rarely apply. However, your choice of doctors and hospitals are limited to a specific network so before you select a plan, make sure that your preferred doctors and hospitals are in that network.

PPO plans also work within a network of physicians and hospitals. While PPOs generally have higher premiums and deductibles than an HMO, you have the added freedom to see any specialist without a referral, but, you may pay higher out of pocket costs if they are not in the network.

A Point of Service plan, although not common, is a blend of both HMO and PPO. It allows you to choose either in or out of network at any time. When you see physicians within your network, your cost may be lower. But when you want to see a physician outside your network, you will likely have to satisfy a high annual deductible, co-insurance and co-pay.

Those who are eligible, have access to Medicare, Medicaid or Veterans Administration coverage.

Medicare is for those 65 or older, and people under 65 with certain disabilities and diseases. There are four different parts of Medicare. Check with your doctor or local hospital for classes and information to learn more about your coverage options and eligibility.

Medicaid is a state administered plan that pays medical bills for those who meet strict eligibility and income requirements.

The Veterans Administration (or VA) is a federal program delivered in government-owned VA hospitals and facilities. To qualify for VA health benefits you must have served active military duty and been discharged honorably.

Take the time to compare different plans to ensure you get the coverage you need while minimizing your out of pocket costs. But Before you finalize your choice of healthcare plan it is critical that you read the summary of benefits and ensure your preferred doctors and hospital are in that plan’s network.

To view the rest of the videos in the 5-part series and to discover additional resources and tools visit PIHHealth.org/Resources

Be sure to “Like” this video if you found it helpful and follow us Facebook, Instagram, Twitter @PIHHealth

Welcome to Navigating the Healthcare Maze. You’re watching part 4 of this 5-part video series.

In these videos, you will learn about the different types of insurance coverage, where to receive care, and how to understand your medical bills so that you can take control of your health.

One of the most confusing parts of healthcare are the bills and statements that you receive. This video will break each of them down and show you how to make better sense of them.

If you go to an emergency room or are hospitalized, you may receive a facility bill, often called a hospital bill. This type of bill includes charges for services you received such as surgery, physical therapy, laboratory services or medications.

You may also receive one or more professional bills, often called doctors’ bills. These bills can come from different doctors, such as the emergency room doctor, surgeon, or anesthesiologist. Even if you don’t see a specific doctor in person, like a radiologist, they are instrumental in contributing to your care.

A professional bill may also come from doctors you see outside the hospital, such as your primary care doctor or specialist.

Both types of bills contain similar information. Here is an example of a facility bill

• The statement date is the date your bill was printed
• Date of service is the actual date you received your care
• Total charges show the full price of the services you received
• The “Insurance payment” line indicates the payment your insurance company has already made, so you are not responsible for paying that amount
• You’ll want to pay attention to the Amount You Owe line. This is the amount you are responsible for paying

In addition, you may receive an Explanation of Benefits or an EOB.

An EOB is a statement from your insurance company that summarizes the care you received and the amount you may owe. Most contain:

• The date and description of service
• Total charges
• Allowed charges, or the negotiated rate between the health plan and the provider
• Discount or adjusted amount, which is the difference between the total charges and the allowed charges
• Co-pay, the fixed amount you pay per visit
• Deductible, the amount you must pay before your insurance starts to pay
• Co-insurance, the percentage of charges you owe after your deductible is met
• The amount paid by the insurer or health plan
• And, the patient responsibility, or the amount you may owe

You should always compare any bills you’ve received to the EOB before making payments to ensure you only pay what you are responsible for.

If you have any concerns or questions, call your insurance company, doctor’s office or hospital to clarify.

To view the rest of the videos in the 5-part series and to discover additional resources and tools visit PIHHealth.org/Resources

Be sure to “Like” this video if you found it helpful and follow us on Facebook, Instagram, Twitter @PIHHealth

Welcome to Navigating the Healthcare Maze. You’re watching part 5 of this 5-part video series.

In these videos, you will learn about the different types of insurance coverage, where to receive care, and how to understand your medical bills so that you can take control of your health.

This final section in our series will help you understand your role as a patient so that you can get the most out of your healthcare coverage.

You may have heard of something referred to as the Patient’s Bill of Rights. But, really it’s both your rights and the responsibilities you share related to your health.

So what are some of the rights you should be aware of:

• You have the right to keep your medical records private and to request your own copy.

In addition, you have the right to the following:

• To ask your doctor questions until you have the information you need to make an informed decision.
• Timely access to specialty care
• Clear understanding of coverage payments and the right to appeal
• You also have the right to a reasonable choice of doctors

Along with your rights, you also have Responsibilities

You have the responsibility to:

• Pursue a healthy lifestyle
• To understand your health plan’s benefits and where you are covered to receive care
• It is your responsibility to actively participate in decisions about your care and then follow the treatment plan that you and your doctor discussed
• As well as to make a good-faith effort to pay your healthcare bills.
• To ensure your desired wishes are honored by your family and medical team if you are not able to make decisions for yourself, you need to complete an advance healthcare directive
• And don’t forget to enroll in your health system’s online patient portal to access your health information and communicate with your doctor’s office This will give you the ability through a mobile app or computer to see and print test results, schedule or view upcoming appointments, request prescription refills, and to privately email your doctor.

Be sure to ask your doctor or hospital if there is a patient portal available and how you can enroll.

Before we wrap up, here are 10 important things we hope you’ll take away from, this video series

to help you get the most out of your healthcare coverage.

1. Maintain a healthy lifestyle.
   1. Set goals for eating healthy and staying physically active. Consider taking health education classes.
2. Take preventative care seriously.
   1. This could include cholesterol checks, breast exams, diabetes screenings, and colonoscopies.
3. Build a relationship with your primary care doctor.
   1. Schedule regular doctor visits and annual checkups. Prepare a list of questions and be sure to ask who you should contact for questions that may arise after your appointment.
4. Take medications as prescribed and complete follow-up visits.
5. Choose the best health insurance for you and your family – and stay in-network.
   1. Before you select a plan, make sure that your preferred doctors and hospitals are in their network. Review and understand your insurance plan’s Summary of Benefits and know what your costs will be.
6. Enroll in your provider’s patient portal.
   1. Ask your doctor or nurse if there is a patient portal available and how you can enroll for easy online access to your doctor and personal health information.
7. Keep your insurance card and important health-related information with you at all times.
   1. Remember most insurance cards have a free 24/7 nurse advice phone line to help you decide what to do or when to seek further care.
   2. You should also keep a list of medications you take regularly, allergies, previous surgeries, advance directive information, the name of your emergency contact, and your preferred hospital.
8. Know where your local urgent care center is located.
   1. Depending on the situation, this may be a good option for your illness or injury. For life threatening emergencies call 911 or go to the nearest emergency room.
9. Compare healthcare bills with your Explanation of Benefits (EOB) statement
   1. You should always compare any bills you’ve received to the EOB before making payments to ensure you only pay what you are responsible for.
10. Finally, remember your patient rights and responsibilities.
    1. Make the most of your powerful role as a patient. Use the tips you learned in this video series to manage your health and make sure you are on the healthiest road possible.

While navigating healthcare may look different for everyone, we hope you have learned some useful tips for getting the most out of your healthcare coverage and staying on your best path to health and wellness.

To view the rest of the videos in the 5-part series and to discover additional resources and tools visit PIHHealth.org/Resources

Be sure to “Like” this video if you found it helpful and follow us on Facebook, Instagram, Twitter @PIHHealth