How Knowing Your Health Plan Can Improve Your Experience at the Doctor’s Office

Tick. Tick. Tick. Alone in the exam room, the clock is slow and loud. As I wait nervously for the doctor to open the door, I review questions in my head. Yet when the doctor arrives, time magically speeds up, I forget what I was going to ask, and the appointment is over in minutes. Sound familiar?

Because doctors are authority figures, we often give them the benefit of the doubt or expect them to read our minds. But if we want to have better health care experiences, we need to be proactive—and that means understanding our role as patients and being willing to speak up when we have questions. Working in the health care industry—in doctors’ offices and on the health insurance side—has given me a better idea of how we, as patients, can do better.

Here are three tips for improving your next doctor’s visit and feeling more prepared when the bill shows up afterward:

• Know why you’re going and say so

If you aren’t clear about why you made the appointment, your doctor might not be, either. Make a list of your questions or concerns, bring it with you, and don’t be afraid to refer to it while you talk. When time is tight, it helps to prioritize what matters most. Are you really there just to refill a prescription or do you want to ask about symptoms that have been nagging you for weeks? This is your appointment.

• Don’t assume your doctor knows your health insurance plan’s rules

Doctors can’t memorize everyone’s health coverage—but you can get to know the basics of your plan. Knowing what your health insurance covers and being willing to ask questions can save you money. For example, when your doctor prescribes a new medication, your health insurer’s app or website may be able to tell you if there are less expensive drugs in the same category (hint: these are often generic).

I’ve taken in a list of the medications covered by my plan and asked whether one of the Tier 1 drugs might be an acceptable alternative—often, the answer is yes. Other times, I’ve had doctors tell me that something about a medication or a visit was a requirement by my health insurer, but when I investigated further, that wasn’t the case. If you’re a Select Health member, don’t be afraid to call and ask if something doesn’t seem right!

• Read your EOBs

An explanation of benefits, or EOB, is the document that tells you what your doctor (or a facility) billed and how it was covered. The EOB will tell you how much you are responsible to pay, how much applied to your deductible and out-of-pocket maximum, and how much was paid to your doctor.

So, how can this help you have a better doctor’s visit? Being aware of costs will help you make better decisions. I’ve had doctors want to perform a test or scan, and when I’ve asked whether that will change how they treat my problem, if the answer is no, I politely decline the test. If they’re going to give me the same prescription or tell me to do the same thing, why spend the money? On the flip side, I’ve occasionally received EOBs with charges on them for services I didn’t receive. Reading your EOBs will make you a more informed consumer. While you’re at it, sign up for paperless EOBs—it’s easy and you can find everything you need online.

We’d love to hear what you do to make your experience better at the doctor and with your health plan. The best way to improve health care is to stay informed, be willing to ask questions, and speak up for yourself. Your health and your wallet depend on it!

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The content presented here is for your information only. It is not a substitute for professional medical advice, and it should not be used to diagnose or treat a health problem or disease. Please consult your healthcare provider if you have any questions or concerns.