This article was last updated on May 28, 2020.
When Wellmark member Judi Weiland was diagnosed and treated for Parkinson's disease, she learned that one doctor’s diagnosis isn’t necessarily the final word. She also learned that being her own patient advocate helped her gain a better sense of control and confidence in health care decisions. A health care advocate represents the patient's best interests. This could be a close friend or family member. And, if you're able, it's important to be one for yourself.
For example:
- According to Kaiser Family Foundation, 4 in 10 survey respondents don't understand basic health insurance terms External Site. Understanding your health coverage could save you from costly, unexpected medical bills.
- 1 in 20 Americans fall victim to outpatient diagnostic errors External Site, according to the Agency for Healthcare Research and Quality. Seeking input from another physician could spare you unnecessary medical costs and tests, and help you get the right diagnosis.
- According to Medical Recovery Services, an organization that helps patients identify and correct errors in their medical bills in order to lower them, as many as 8 in 10 medical bills contain errors. Before you pay, call your doctor or Wellmark with questions.
Choose and use a personal doctor
Finding a personal doctor who is right for you is a smart decision. It ensures you have someone who knows you and your health, and can help you make health care decisions. But, your relationship with your personal doctor is a two-way street. For it to work, you need to be your own health care advocate.
8 ways you can be your own patient advocate
So, how can you be an advocate for your own health care? Here are eight things you can do.
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Understand your health plan
Know the basics of your health plan and how it works. Register for and log in to myWellmark Opens New Window to have that information at your fingertips.
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Tell your history
Be open, honest, focused, and specific. When did your problem start? Have your symptoms improved or gotten worse? What treatments have you tried?
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Ask questions
If you don’t understand something, ask questions until you do. Take notes, or if you have a smartphone, use it to record information you need to remember, and add reminders to help you follow through. If you get home and need clarification, or if you have additional questions, call your doctor.
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Track your tests
What are they for and what will they show? When can you expect results? Is there another option to get the same information?
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Be prepared
If you need help understanding, bring a friend or family member with you. Bring a list of your medications. Write down instructions so you’ll remember them later.
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Do some research
Instead of typing your diagnoses into any internet search, use reliable websites from well-established groups, like the American Cancer Society External Site. Or, look for sites that end in .gov or .edu.
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Watch out for red flags
Are your symptoms common (fatigue or sore throat), but your diagnosis rare? Have your symptoms not improved with treatment? Is your diagnosis based on one test only (maybe the results were wrong)? Talk openly with your doctor about the possibility of a misdiagnosis.
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If necessary, seek a second opinion
If your questions aren’t being answered, arrange to see another doctor for another opinion.
Tools to help you
Log in or register for myWellmark Opens New Window, for a variety of resources you can use when deciding where to get care:
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Compare quality
Find in-network providers with locations closest to you. You can read patient reviews and check quality scores to find a doctor that’s the right fit.
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Compare costs
Using your specific health plan benefits information, you can find estimated costs for services and procedures from a physician and/or facility near you.
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Top centers for specialty care
Blue Distinction® External Site is a national designation program that recognizes health care providers that demonstrate expertise in delivering quality specialty care safely, effectively and cost-efficiently. It is awarded to high-performing medical facilities in certain areas, including bariatric surgery, cardiac care, knee and hip replacement, spine surgery, transplants, cellular immunotherapy and gene therapy. This designation helps make it easier for you to find quality specialty care.
Blue Distinction Centers (BDC) met overall quality measures for patient safety and outcomes, developed with input from the medical community. A Local Blue Plan may require additional criteria for providers located in its own service area; for details, contact your Local Blue Plan. Blue Distinction Centers+ (BDC+) also met cost measures that address consumers’ need for affordable healthcare. Each provider's cost of care is evaluated using data from its Local Blue Plan. Providers in CA, ID, NY, PA, and WA may lie in two Local Blue Plans’ areas, resulting in two evaluations for cost of care; and their own Local Blue Plans decide whether one or both cost of care evaluation(s) must meet BDC+ national criteria. National criteria for BDC and BDC+ are displayed on www.bcbs.com. Individual outcomes may vary. For details on a provider’s in-network status or your own policy’s coverage, contact your Local Blue Plan and ask your provider before making an appointment. Neither Blue Cross and Blue Shield Association nor any Blue Plans are responsible for non-covered charges or other losses or damages resulting from Blue Distinction or other provider finder information or care received from Blue Distinction or other providers.
Get extra support
Dealing with the health care system can be a daunting task, especially if you are in poor health, or if you are trying to coordinate for a loved one from a distance. Health Advocacy, a service you can access by calling BeWell 24/7 Opens New Window, can help take some of the stress and hassle out of the process.
Call BeWell 24/7 to get help from a health advocate for health care issues and tasks like:
- Locating physicians and facilities, including quality-designated providers
- Scheduling diagnostic tests or specialist appointments
- Assisting caregivers with scheduling home-care services
- Coordinating with Wellmark Customer Service on complex benefits or billing issues
BeWell 24/7 health advocates are available by phone for questions and support, and to guide you through health care situations that can distract from work and other responsibilities. Just call Eight, Four, Four, Eight, Four, Be Well.
