Healthcare is a Team Game

 By Marc Manor

Healthcare is a team game that includes everyone from the client/patient, to the provider, their staffs, coders, insurance companies and others. When one member of the team, drops the ball, it can result in wasted money and resources and undue stress on the part of the client/patient. Even the most talented doctor or dentist may lose client trust and waste their time (time is money) if they do not have a staff that can handle claims and referrals in an accurate and expeditious way.

Recently, I received a call from a client telling me his primary care provider referred him to a specialist. When he arrived at his appointment, he was told that the specialist was not in network and they would not accept his insurance. This exemplifies a break in the client’s “chain” of care that should never happen. Healthcare is a team game where every decision should be made with the client/patent’s best interest in mind. As a result, the specialist wasted an appointment slot, the client was inconvenienced, and the primary care provider ended up losing a patient!

In this case, the breakdown likely occurred somewhere in the office staff (team) at the primary care provider because of a broken link in the administrative chain when processing a referral or insurance claim. Clients or patients are not healthcare professionals and therefore, do not normally anticipate breakdowns in the system. I have contacted medical and dental offices about this in the past and been told “it is the clients responsibility to make sure these referrals are in network” - a totally unacceptable answer in my view. Fortunately, we were able to use our local resources and find another provider for our client in the above example (and others) who has an established track record for client centered care with efficient claims and referral processing.

 Here are some tips for putting together a strong healthcare team:

 - Seek the assistance of a local healthcare insurance agent to review your healthcare insurance plan. Your local agent can not only help you choose the right healthcare (also applies to Medicare and dental insurance) plan with your needs in mind. An experienced local agent will have knowledge of the local medical groups and hospital networks.

 - When you receive a referral from your provider, ask them if the specialist or other provider they referred you to are in your insurance network. If they don’t know or tell you to call them; red flag 🚩 - they should know.

 - If you have to call to make an appointment where your are referred, ask them if they accept your insurance as “in network.” If they say no or “I’m not sure”; red flag! 🚩

 - Call your insurance company “member” or “customer” service line. While the company may not have the insight or experience with the local providers, they will be able to let you know who is in network for your plan. If they don’t know; red flag 🚩 - call your local agent immediately!

 One last note on networks. Don’t worry about networks if you have an emergency. Go to the nearest emergency room or call an ambulance.

Doctors and medical staffs are people just like the rest of us. Most are dedicated professionals and many are extraordinary and go the extra mile for their patients.  In fact, their heroism has never been more evident than during the current pandemic. By-enlarge, medical professionals are some of the most competent and honest hardworking people in our community. We are blessed to have some of the best here in Northeast Florida. Just like a winning sports team, your healthcare team should operate like a smooth running machine; with you in the drivers seat.

Marc Manor is a 30-year military veteran who is now dedicated to teaching his fellow Americans how to make the most of their Medicare and healthcare benefits. As an independent agent, Marc has access to a wide variety of carriers with an abundance of resources to find tailored solutions. There is no charge for a consultation so call 904-222-0698 or email: marc@marcmanor.com.