Health insurance…does the mere topic strike fear in your heart? Do you have a firm grasp of the verbiage associated with insurance? Is your Huntsville doctor aware of the current system and up to date with requirements? If you’ve ever had to deal with a difficult insurance company, you know how disheartening the experience can be. It is rarely an easy process to file a claim or seek reimbursement for a procedure or medical costs. Perhaps you have had to navigate your way through endless paperwork created to keep you a confused consumer. It may even feel like your insurance provider really isn’t on your side at all.

Statistics from a survey by UnitedHealthcare found that only 9% of consumers have an understanding of simplistic terms associated with health insurance.

The United Healthcare Consumer Sentiment Survey assesses healthcare knowledge and provides valuable insight into a very esoteric institution. Healthcare literacy is a national issue, and you, the average consumer, are often left in the lurches fighting for understanding. Innova Primary Health Care is committed to changing the current healthcare system from the inside out. One of the ways we hope to accomplish this is by empowering our patients through education and awareness. If you do not know how the system currently works, how can you improve it? With knowledge comes empowerment. You, the patient, can make informed decisions about your health care because you have the right tools.

If you are like most, trying to discern health insurance can feel like you are on a sinking ship without much hope for rescue. The good news is that in 2015, bipartisan legislation, MACRA – The Medicare Access and CHIP Reauthorization Act – was passed in an attempt to improve the way clinicians receive reimbursement for the care they provide. This matters to you because the previous compensation standards rewarded volume of care over the quality of service. We are now moving towards a merit-based system. This is fantastic news for you.

Think about it in terms of a hamburger (stick with us here). What if it cost the same for a crummy fast-food hamburger and a high-end burger from a world-renown steakhouse? The highly processed hunk of junk that arrives in a greasy paper bag holds the same value as a gourmet meal. Regardless of excellence, you pay the same. Now, consider your healthcare provider. If there is no difference between the quality of care, why not book as many appointments as possible and go for quantity over quality? Why provide excellent care when are only compensated for doing the bare minimum?

Do you see the problem?

With the passage of MACRA, things are changing, albeit slowly. Innova Primary Care is at the forefront of the movement for making our system better, and we cannot do this without you.

Did you know that insurance companies assign patients with a “risk score” that directly impacts your coverage? Crazy right? To further complicate, you may even have “gaps” in care within your risk score. These gaps partially reflect actions under your control that need to be fulfilled by you, such as getting that colonoscopy if you are of a given age. For example, if you are female you are required to have a cervical cancer screening. When you do not do so, you receive a gap in care which contributes to a risk score given to you by your insurance company. Failure to follow up with referral appointments creates yet another gap. Is your head spinning? Listen, insurance is complicated. We are here to help you navigate through the complexities and get to the heart of the matter.

You can help heal the system.

You can be an active participant in the change that you long to see in healthcare, and we think this is pretty exciting news. You don’t have to sit on the sidelines waiting for a broken insurance system to mend itself. Be a part of the revolution. You get to help by being a part of the renewal process from the inside out. And we are here to work with you to make it happen. At Innova, we are doing all that we possibly can to affect change, to mend the standards. You have our promise that we aren’t sitting idly by asking our patients to take on the burden alone.

So, what can you do? How do you actively work to close the gaps in your own healthcare experience? We are happy you asked!

Here are three simple ways that you can close the gaps in your care, and they are pretty easy to do.

Follow through on referrals

One of the ways to close the gaps is to ensure that you follow through with referrals for care. It is incredibly important to your health as well. If you are asked to see a dermatologist for a suspect mole, know that we have not come to this decision lightly. When we prescribe a specialist for you, it is because we believe it is the best course of action for you.

Many patients do not fully recognize the challenging aspect of contacting other health care practitioners to schedule services on their behalf. This process takes time and effort from your physician’s office. Your primary care physician works meticulously to find a specialized physician to care for your needs. We code this accurately with insurance, and when you do not attend a referral appointment, we reap the repercussions and have a gap in your care. Until you do so, the gap remains.

When you do not comply with referrals, you lose out on necessary health information you need. Your physician does as well. And, because you have chosen Innova Primary Care as your health care provider, we are impacted too.

Take medications as prescribed

We do not prescribe medication lightly. If we prescribe medication, it is because we genuinely believe it is in the best interest of your health. We want to see you get better. We want you to have the ability to keep your chronic conditions under control. However, we cannot sit with you to make sure that you follow your treatment protocol as prescribed.

All too often, people do not take their medications and end up in urgent care facilities or emergency rooms. Your health depends on following the treatment protocol given to you by your physician. When you do not, you are only doing yourself a disservice. And, guess what, when you seek additional medical help, your risk score from your insurance provider changes.

We are not suggesting that you never visit urgent care or the ER. However, you can drastically reduce these visits for chronic conditions by taking your medications correctly. It is vital that you also keep up with your physical exams and referral appointments as well.

Ask questions about your risk score

Every patient has a score assigned to them by their insurance company, and your doctor has access to this information. Have you ever asked what your risk score is? Do you know what gaps in care you have and what you can do to close them? Information is valuable, and the more patients ask these questions of their doctors and seek answers, the larger the tide of change becomes. You get to be a part of the solution.

Innova Primary Care knows that insurance is a topic that most of us would rather ignore. However, we also know that in order for things to change, patients need to be made aware. We want you to be an informed consumer and ask the tough questions. You are not in this alone. You have a right to know how insurance works, and we are committed to helping you do just that.