Navigating a Broken System: Helping Patients Use Health Resources
By Sean Price Texas Medicine March 2022

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Whether patients do or don't have health insurance, they need physicians' help to make the most of their health resources, says Houston internist Salil Deshpande, MD, a member of the Texas Medical Association's Task Force on Health Care Coverage.

“Physicians have a very trusted place with patients. Because of all that expertise and knowledge, they’re best positioned to look at different health insurance options and steer them to reliable resources to better understand which ones will be most appropriate for a patient,” said Dr. Deshpande, also chief medical officer for a large health insurance plan. 

But given the byzantine complexity of the market, most patients have a hard time evaluating health plans adequately, says TMA past president Douglas Curran, MD, who runs two federally qualified health care centers in East Texas and also is a member of the task force. 

Rather than buying what best suits their needs, “I’d say that the vast majority of our patients are buying the cheapest insurance they can without an understanding of what they’re buying,” he said. 

Experts say physicians can help patients make better choices in several ways: 

Encourage patients to educate themselves about their health plans: During open enrollment for Affordable Care Act insurance plans, or after a qualified life event – such as loss of coverage or birth of a child – direct patients to healthcare.gov and community navigators to find out more about health insurance options and costs. Plans with low premiums might have high copayments and deductibles. Likewise, new health insurance options become available each year so patients should compare their plans year-to-year. 

Educate yourself and your staff: Physicians cannot be experts about every aspect of every plan they deal with. But they and staff members build up a day-to-day expertise about how different plans work and ways to help patients.  

Designate staff to counsel patients: Use the expertise that your office has developed to show patients how to get the maximum amount of health care using their insurance plans.  

Be ready with alternate treatments and medications: Physicians frequently prescribe a medicine or a treatment believing it is covered by a health plan only to find out it is not or is very costly. Have different medications or treatments in mind, if possible, when that happens. 

Provide price transparency to patients: Both state and federal law include provisions concerning price transparency. Beginning in January, the federal No Surprises Act required that good-faith estimates be provided to uninsured and certain self-pay patients when scheduling care or when the patient requests an estimate (www.texmed.org/Surprise). 

 Tex Med. 2022;118(2):22
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Last Updated On

March 31, 2022

Originally Published On

February 24, 2022

Sean Price

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(512) 370-1392

Sean Price is a reporter for Texas Medicine and Texas Medicine Today. He grew up in Fort Worth and graduated from the University of Texas at Austin. He's worked as an award-winning writer and editor for a variety of national magazine, book, and website publishers in New York and Washington. He's also helped produce Texas-based marketing campaigns designed to promote public health. Sean lives in Austin and enjoys hiking, photography, and spending time with his wife and two sons.

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