Author Archives: Dianne Savastano

Lessons From The Front Line: Common Health Care Questions and Answers

Studies regarding job satisfaction have demonstrated that beyond basic financial security, it is things like autonomy, working with people you respect and feeling that your labors are meaningful/making the world better, that contribute to happiness at work: “A job is usually more than just a means to a paycheck. It’s a source of purpose and meaning, a place in the world.”

In my case, there were many times while working in varied corporate roles when I wondered if what I had done all day had any real value. Today, by contrast, I am happy to say that I feel extremely fortunate — I LOVE what I do at Healthassist!

Sharing my insider knowledge of how the healthcare system works with clients — many of whom feel frustrated and overwhelmed — and helping them to achieve a sense of mastery and control, is incredibly gratifying and keeps me working very hard on their behalf every day.

Recently, after receiving many requests (often in social situations) for some “on the spot advice” about a healthcare or insurance situation, I decided to make this a standard offering: Clients simply register online for a one-hour, as needed phone consultation at their convenience.

I’ve done many of these now and have found that certain topics come up again and again, including:

Doctor-Patient Relationships

If you have a primary care physician or specialist with whom you don’t feel completely satisfied, rest assured that you are not alone. I hear this one frequently!

Clients report that while they may have regard for the physician and his/her competence, they describe interactions they perceive to be one-sided; they just don’t feel listened to and/or heard.

In these circumstances, my advice is to always assume the physician is also motivated to have a mutually satisfying interaction. The first action, therefore, is to address the topic of “our relationship / communication,” and to include it on your agenda for the next scheduled meeting.

Here is what you can say when you sit down together:

“Our mutual relationship is of great value to me and I’d like to expend some effort on enhancing it. I’d like to discuss how we communicate and what works best for both of us.”

From there, you can discuss past interactions (how they left you feeling and how you would have preferred them) as well as what you would like to see going forward (e.g., sharing your agenda at the beginning of a meeting, sending an email in advance, your preferences regarding phone conversations).

Most physicians tell me they are grateful when a patient brings up this topic, especially when a patient feels unsettled. They recognize that methods of communication need to be customized to each patient and are eager for the opportunity to improve.

Medicare: When to enroll? How to enroll? What to choose? Help!

There are many options regarding when, how and at what level to enroll. These variations are necessarily specific to each individual and my work with clients focuses on sorting all of this out and creating a customized game plan.

One area that people find particularly confusing is the difference between Original Medicare and a Medicare Advantage Plan.

Original Medicare, including Part A and Part B, pays for approximately 80% of health care costs. If you add a Medigap/supplemental plan, it can cover all your healthcare costs and result in little out-of-pocket expenses. I call this a “pay up-front” plan and it generally costs more than the option below.

A Medicare Advantage Plan, on the other hand, functions like an HMO or PPO plan obtained through employers. It may or may not have an additional premium and deductible associated with it and always has additional out-of-pocket expenses for co-pays and co-insurance amounts. I call this a “pay as you go” plan, and while it may appear to be less expensive, the devil is in the details of how, where and when you access care.

A careful analysis of an individual situation, taking into account preferences for coverage, other family members that must have health insurance, where you live and your income from the two years prior to reverting to Medicare, all must be considered.

Working with my Insurance Company

Questions in this area tend to focus on understanding the various components of insurance and coverage, as well as how to file claims for things like long-term-care insurance policies.

One topic that nearly always arises has to do with the difference between an HMO (Health Maintenance Organization) and a PPO (Preferred Provider Organization).

An HMO is the more restrictive of the two. You must identify a primary-care physician, you must obtain referrals from her/him to see specialists and you must stay within a network of doctors and hospitals.

A PPO has fewer restrictions. It does not always require you to have a primary care physician or to obtain referrals. Also, financial coverage is greater if you stay within the network of doctors and hospitals. If you go outside the network, you still have some financial coverage.

Summary

I have the incredible privilege of waking up every day knowing that I love what I’m going to be doing. Having a fabulous team of highly skilled professionals to work with contributes to that feeling.

But mostly, it’s the clients I love — the ability to enter their lives at what often are very vulnerable times, to develop a relationship with them, and to share some of my insider knowledge in the hope of making their lives just a little bit easier. To me, that is simply the best!

Recommended Reading: Paid Leave

I appreciated this recent commentary regarding paid leave and the caring of the older adults in our lives. Click here to read.


I remain committed to Simmons University for so many reasons, one of which is the university’s research on gender in organizations.

For example, at the last four women’s leadership conferences I attended, “men allyship” was a subject of discussion. This important topic has gained much visibility, both as a role that individual men take up, as well as an organizational strategy for enhancing gender equity. Take a look at some recent findings, here.

Uncoordinated Care — Tips for Managing When Healthcare Systems Don’t “Talk” to One Another

Over the past few weeks, two of our clients have run into difficulties coordinating care across multiple healthcare systems and providers.

One client receives some care from Boston Medical Center and additional specialist care at Beth Israel Deaconess Medical Center. Recently, he decided to see a specialist associated with North Shore Medical Center (Northern Division of Partners Healthcare).

Another client receives care from a Rhode Island based primary care physician as well as from a specialist at Brigham & Women’s Hospital. She was preparing to visit Dana Farber Cancer Institute.

If you live here in New England, these institutions will no doubt be familiar. What might be surprising, however, is the degree to which these institutions do not share patient medical records with one another.

In these two examples, this meant that my clients — and my staff! — had a lot of work to do to make sure the information flowed completely, quickly, and to those who needed it. But it was much more difficult than it should have been!

A Little Bit of Background

The use of Electronic Medical Record systems (EMR) has exploded over the past 10-15 years. As a frequent user of healthcare information for clients, family and myself, I am thrilled to have such easy access… sometimes!

The problem is that despite the Health Information Technology Provisions legislation passed as part of the American Recovery and Reinvestment Act of 2009 — not to mention the more than $49 billion allocated as part of this to, “support and promote the adoption, implementation, and use of interoperable Electronic Health Records” — consumers continue to be faced with a lack of record-sharing among institutions.

And, because there is no single repository for all of our healthcare information, this broken “system” allows for duplication of testing, wasteful cost and the potential for lost information at every step.

What’s the Solution?

As healthcare consumers preparing to see physicians for evaluations, and given the lack of information sharing described above, we must take responsibility on our own behalf.

That means being prepared to share our complete medical histories, clearly describing our experiences with our respective bodies, and taking active steps to overcome administrative barriers that can impede communication and efficiency.

Only then can our physicians assimilate the relevant information, develop a preliminary diagnosis, establish a plan of care, educate us about the evaluation, and guide us through the next steps.

Here are some suggestions:

  • Prepare a complete list of your medical conditions, surgeries, and hospitalizations. Additional items that can be included on the list are procedures and vaccinations. In addition to informing your physicians, this document can help you remember things about yourself and your medical history that could be relevant to a new healthcare situation.
  • Prepare a complete list of all your medications — both prescribed and over the counter. Be sure to include the dosage, how often you take the medicine, what you take the medicine for and who prescribed it (if applicable).
  • Prepare a complete list of your healthcare team members and specialists, including names, addresses, telephone and fax numbers.
  • Enroll in and use all the Patient Portals to which you have access to prepare the documents above — much of this information may already be there, including vaccinations and past procedures. That said, don’t count on the data to be complete and/or accurate; review it all very carefully.
  • Print and bring with you any diagnostic testing results relevant to your situation. This may include blood work, X-Ray images, MRIs, etc. This saves time, money and needless exposure to things like additional X-Ray radiation should a given physician not have access to your information electronically.
  • Prepare a written agenda, stating your objective, a list of topics you want to discuss and specific questions you want to ask.
  • Bring a Care Partner to act as another set of ears, a scribe and a person who can ask questions you may forget to ask in the moment.
  • At the end of your appointment, ask the physician to dictate an “office visit note” and request that he/she send it to all your relevant team members — AND a copy to you! Take responsibility for this — unfortunately, you cannot depend on the administrative systems to work behind the scenes. Request your own copy of the note so that if the system doesn’t work, you can share it yourself.
  • If you believe that direct coordination of care between physicians is critical, ask the physician to make a telephone call and have a live conversation (if possible, while you are there). Nothing can replace the clarifications that occur with real time interactions. (Yes, I know, this is a radical idea!)

Summary

We have made tremendous progress in recent years in the collection of huge amounts of healthcare data and with the sharing of it with healthcare consumers. But there remains much to be done, particularly in the sharing of this information across disparate systems.

In the meantime, take responsibility for ensuring that your vital information is readily accessible and shared as needed. I guarantee that if you take the time and expend the effort, you will have more satisfying and productive experiences. We all must do our part.


P.S. One last thing. I strongly believe that all of us should have access to the notes physicians write about our encounters with them. Some Patient Portals have “Open Notes,” a system that allows you to review and download all this information.

It is unconscionable to me that with the billions of dollars being spent on new medical record systems that all Patient Portals do not offer this feature (including some of the major players in the Boston healthcare market). Our medical records are OURS and transparency is invaluable to better healthcare. Can you tell I feel passionately about this issue?!

Recommendations for Managing Your Insurance Company

Last week, I was invited to provide a 10-minute presentation about Healthassist services to a lunchtime meeting of the Entrepreneurial Women’s Club. I began by asking the audience if anyone had ever experienced frustration with the healthcare system. There were lots of sighs and chuckles, of course!

When I asked for examples, a few people mentioned issues with physicians (providers). But there were many more comments regarding frustrations with health insurance companies themselves (the payers).

Having spent approximately four hours on the phone the week before to troubleshoot a bill sent to my father, I could relate!

A little bit of background…

My father is enrolled in a Medicare Advantage plan, as are 20 million other Medicare beneficiaries (34% of the total). We selected this plan together because of a unique benefit it offers, something called a “Passport Program.” As the name suggests, this allows my dad access to a wider scope of doctors and hospitals in the insurance company’s provider network, something that is important since my dad spends five months of the year in New England and the remainder in Florida.

The program is uncommon, so we are always prepared to provide written information to each doctor’s billing team, so they know he is not required to obtain a referral and that their services are considered “in-network” — and, therefore, paid for at a higher rate.

Each May, when my dad comes to New England, he calls the insurance company to turn on the benefit. Every October, he calls again to turn it off. He’s been doing this for years and it’s worked out beautifully as he has utilized the healthcare system quite a bit and his out-of-pocket costs were kept to a minimum.

He did it again this year, knowing he was having knee surgery. Needless to say, he was shocked when they sent the bill and told him his benefit was paid at the out-of-network rate. At that point, I knew it was time for me to get involved.

Getting to the bottom of things

During my many hours of calls, I encountered several customer service representatives who told me some or all of the following:

  • The Passport Program did not work the way I thought it did
  • My father had not turned on his Passport Program back in May
  • Neither his doctor nor the hospital was an in-network provider (even though I was staring at the insurance company’s web site which listed them as such)
  • The claim was processed correctly, and my father was responsible for the balance

After polite insistence that the situation be escalated, I finally encountered a knowledgeable and competent supervisor who agreed to research the situation and get back to me, in addition to giving me her direct phone number.

Fortunately, as of this writing, I have received three updates, all of which have confirmed that the providers were in-network and that the claim is being reprocessed.

Whew! It’s hard not to feel frustration and resentment at the amount of energy and effort I have spent on getting this corrected — and I do this for a living! I can only imagine how it feels to someone who does not.

Recommendations for getting better results

I make it a practice to scrutinize all bills from medical providers to ensure claims were processed correctly, according to the outline of the insurance contract. If something does not make sense, I begin calling.

Here are some suggestions for managing your insurance products:

  • Know what insurance plan you bought and appreciate all the requirements of the product, for referrals, notifications, etc. Follow the rules as outlined in the contract.
  • If you have someone in your life capable of helping you troubleshoot issues, research how to give that person permission to call on your behalf and complete the necessary paperwork.
  • When you receive a bill and don’t understand it, call the provider’s billing company first and ask how it was paid by your insurer. See if that matches what you read in the policy. For example, if in-network benefits were supposed to be covered at 80%, was it paid that way?
  • Call the insurance company next and have your ID card, the bill and any other paperwork about the bill in front of you.
  • Look up the benefit in your policy/evidence of coverage so that you know how the benefit should have been paid.
  • Keep a running list of times, dates and people you’ve spoken with when you call. Ask if they are documenting your interaction in their system.
  • If you don’t feel comfortable with an answer, call back at another time and get another opinion. If you are still unclear, ask for an escalation to a supervisor.
  • Maybe most important, be extremely polite and diplomatic. That’s important in getting the results you want. For example, I found myself saying the following:

“Please help me to understand what you are telling me as it is different from my understanding.”

“I know you are trying hard to assist me and I appreciate that. I find we are not in agreement; can we pull in your supervisor for a consult to help me understand?”

“I appreciate your efforts. I’m just not satisfied with this outcome and would like it escalated to someone else in your organization. Who can assist us?”

Conclusion

Conducting extensive research when choosing an insurance product is necessary to help you understand what you are buying as well as how best to use the product. But it doesn’t end there. Make sure benefits are paid as they should, be assertive, and question when you think a mistake has been made.

Oh, and practice some deep breathing and relaxation exercises before making any phone calls about bills and claims!

Recommended Reading: Atul Gawande

In a recent article, Atul Gawande reflects on technology/electronic medical record systems and their impact on the physician patient relationship:

“And yet it’s perfectly possible to envisage a system that makes care ever better for those who receive it and ever more miserable for those who provide it.”

“We can retune and streamline our systems, but we won’t find a magical sweet spot between competing imperatives. We can only ensure that people always have the ability to turn away from their screens and see each other, colleague to colleague, clinician to patient, face to face.”