Episode 4 Navigating the American Healthcare System
Episode 4—Navigating the American Health Care System
I am Feroz Bashari. Today, I am going to give you some advice about the Americans medical system and what you need to know to be able to use it to the benefit of you and your family.
1. First of all, you need to have some form of health insurance. Without it you can end up deep in debt.
2. Secondly, American doctors are very well trained. They usually have 12 years of college training. The American system of training doctors is considered the best in the world.
3. Many medicines need a prescription from a doctor. The reason for this is that taking the wrong medication or too much of a medication can lead to serious health problems.
4. People
need a primary care doctor so that they do not have to use the emergency room
for every illness. A primary care doctor
looks after your overall health care needs and looks for problems you would not
be aware of.
5. It helps to keep good records of vaccinations and other medical information. You are going to be asked for it every time you see a new doctor, and so will each of your family members. To keep it simple, use your phone to take pictures of medicine bottles and any medical records that you have. Be ready to tell the doctor about any chronic health conditions that you have.
Healthcare in
America is very expensive. For that
reason, payment for services usually involves insurance of some sort.
What is health
insurance? You pay a certain amount for
it every month whether you use it or not.
Then if and when you need medical care, it pays much of the bill for
you. It does something else, too. It negotiates with doctors and hospitals so
that they charge lower fees. If you
don’t have insurance, you will probably pay a higher cost for medical care, and
it could be a debt that follows you many years if you do not have the money to
pay it right away.
Many Americans
have insurance policies through the company for which they work. Small companies do not have to offer it, but
large companies do. This is another
advantage of working—having health insurance at a reasonable cost. Some policies are better than others. Large American companies sometimes have the
best insurance.
In addition,
anyone can purchase private health insurance.
However, the cost is generally higher than for insurance through an employer. Some young adults do not feel the need for
health insurance, and if they are healthy, they may not need it right away. However, if they become injured in a car
accident or suffer some unexpected illness, they can end up with a hospital and
doctor bill of many thousands of dollars.
It is generally best to have some form of health insurance even if it is
not very good because you will be charged only the lower rate which has been
agreed upon by the doctor and the insurance company.
Medicaid is the
nation’s health insurance for people with low incomes. States determine an income level which
qualifies a person or family for coverage.
All states have to provide certain benefits, and some states provide
even more benefits. Benefits which all
states provide through Medicaid include,
Hospitalization
Doctors’ visits
Nursing facility services
If you live in
Oklahoma and have SoonerCare, you have these benefits:
Prescriptions
Ambulance service for emergencies
Emergency room services
Dental care
Medical equipment
Birth control supplies
Mammograms
Home health care
Hearing evaluations
Immunizations
Lab tests and x-rays
Drug and alcohol treatment
Rides to the doctor
For children, it
also provides wellness checks, hearing aids, braces for teeth, eye exams and
glasses, and speech and physical therapy.
Another form of
health insurance was created through the Affordable Care Act. This was a type of national insurance passed
under President Obama. People sometimes
call it Obamacare. Anyone can purchase
it. If at some point you no longer have
Medicaid, you may need to purchase this type of insurance.
Medicare is insurance
for people over 65 and for people who are disabled.
If you ever find
yourself without insurance, ask the doctor or hospital for their “cash rate.”
You may be able to get your healthcare at a lower cost that way.
In choosing a
doctor, you may have to pick one from a list provided by the insurance company. Be sure that whoever you see accepts your insurance. Usually, the doctor’s staff will make sure
that your insurance will pay him. But to
be safe, check for yourself by calling the insurance company or looking on
their website to see if the doctor or hospital is in network. Otherwise, you may end up responsible for the
entire bill.
Why is healthcare
in America so expensive and what can I do about it? There are a variety of reasons for why it is
expensive. One reason is that doctors
have had to go to school for a very long time to become expert in their
field. Typically, they have eight years
of college and four years of residency.
Sometimes they have even more education if they choose to become a
specialist. All of this training is very expensive for the doctor, and it is
part of the reason that medical costs are high.
U.S. doctors are
considered the best doctors in the world.
You can usually trust your doctor to use all his skills and experience
to do his best to provide the most effective possible treatment. Therefore, it is important to trust your
doctor and follow his directions unless you have a good reason not to.
The best thing
you can do to keep your medical expenses down is to make sure that you have
some form of insurance for your family. Even
poor insurance is usually better than no insurance. Another thing which you can do is to practice
good health care, such as eating nutritious foods, exercising, and not smoking.
Part II
When you call to
set up an appointment to see a doctor, you may be unhappy to learn that it may
be 2-3 days before he or one of his associates can see you. Most doctors are very busy and see a large
number of patients on a daily basis. If
you believe your problem is more urgent you can stress this over the phone and
ask to be worked in. The other option is
to go to an urgent care clinic.
When it is time
to go to the doctor do not be late. You
will check in with the receptionist as soon as you arrive. That person will check your insurance card
and identification card. If this is your
first time to see that particular
doctor, you will need to allow time to fill out a medical history and questions
about your symptoms. It is a good idea
to have a health history already written out on your phone, tablet, or
computer. Prior to the visit, it can
also be helpful to write down the symptoms you have been having so that you
don’t forget to mention everything to the doctor. You will need to be ready to answer some
standard questions such as your past surgeries, past hospitalizations, and
current drugs that you are taking. Sometimes you will end up waiting for what
you consider too long for the doctor to see you. If you have waited more than 15
minutes you need to alert the receptionist who will notify the doctor.
The physical exam. The doctor will ask you what problems you
have been having, how long they have been going on, what makes them better,
what makes them worse, and so on. He or
she may gently touch and probe a part of the body where you have pain. Usually, the doctor’s nurse will measure your
body temperature, blood pressure, weight, and oxygen levels. The doctor will look in your nose, ears,
mouth, throat, and eyes. He or she will
generally use a stethoscope to listen to your heart and lungs. It is unlikely that a doctor will touch any
private parts of your body unless they are directly related to your
complaints. Even then, for female
patients, a nurse will be present. Very
often your doctor will want to run blood tests and may order more extensive
tests to be done at a later time. It may
take a week or two to get the results of these additional tests. This can be a frustrating experience.
Some people who
are not used to physical exams are not comfortable with a doctor touching
them. First of all, you have a right to
say no to the physical exam. Secondly,
you can usually choose to have a doctor of your same gender to examine you. Female doctors are usually available in most
medical facilities. In America patients are encouraged to ask questions of
their doctor. This is especially true if
you don’t understand his recommendations or feel that he is not understanding
your concerns. You should also be
prepared for the doctor to ask some sensitive questions. These might include questions about your
bowels, about your family relationships, stresses you are dealing with and
mental health issues such as depression.
American doctors understand that
some physical symptoms such as fatigue, headaches, upset stomach, insomnia and general aches and pains can
result from psychological stress and family tension.
Why can’t I just
go buy medicine at my drug store like I did in Afghanistan? While it is sometimes true that patients can make
an educated guess at the medicine they need, most people do not know enough to
choose their own medication. Many people
believe they need an antibiotic to treat their problem, but many common
illnesses are caused by viruses and doctors now know that they don’t respond to
antibiotics. The over prescribing of
antibiotics in the past has lead to antibiotic resistant illnesses. If the
doctor does prescribe antibiotics you need to take the whole prescription even
if you are tempted to stop taking it as soon as you feel better. This is to insure that you don’t relapse. In
addition, if you don’t see a doctor for a persistent problem you need to realize
that guessing at what is wrong with you can lead to overlooking serious medical
problems.
Many illnesses
such as the flu can be treated primarily with over the counter drugs such as
Tylenol, Advil and cough and cold medicines that don’t require a prescription For children over three months of age, fevers
that are below 104 degrees can be treated with an over the counter pain and
fever reliever combined with a tepid bath.
Never give aspirin to children, however.
You need to be aware that insurance will not pay for over the counter
medicines, and some name brands may be expensive. It is wise to buy the store brand of these
medicines in order to save money. You
may be tempted to use a home remedy rather than go to the doctor. That is not wise. If you have a family doctor, check with him
first before using a home remedy.
Moreover there may be an over the counter medication that may be more
effective.
Should I keep my
sick child home from school? Usually, if
children are running a fever of 100.4 degrees or more, they need to be kept
home. Vomiting, headaches, coughing, sneezing, headaches, body aches, and
severe sore throat also would warrant keeping a child home. Children with colds are contagious for 48
hours after the onset of symptoms. Different
school districts are likely to have different policies about this. Check with your child’s school. Sometimes children who are stressed about
going to school will develop physical symptoms.
This can cause excessive absences and lead to them being held back.
What do I do if I
don’t like my doctor? In most
situations, you will be able to change doctors if you choose. You can also discuss your complaint with the
administrator of the medical practice. If you believe the doctor is not
providing effective treatment you have the right to get a second opinion from
another doctor. Your insurance usually
pays for this, and it is an acceptable practice in the U.S. Patient advocates are
available at hospitals if you are dissatisfied with the treatment you are
receiving at a hospital.
What do I do if I
feel that a hospital, doctor or other health professional has not treated me
correctly? Talk to the doctor first. If you are not comfortable with that, talk
with his superior or a hospital administrator.
If all else fails, you can contact the state medical licensing board to
complain.
Should I call an
ambulance when I am sick? Not usually. Ambulance calls are very expensive and only
for emergencies. If the insurance company decides it was inappropriate use of
an ambulance, you may end up being responsible for paying for it. What kinds of symptoms would you look for in
deciding whether it is medically necessary to call an ambulance or not?
If the person is having difficulty
breathing.
If a person is nonresponsive or unconscious.
If there are signs of a stroke, such
as inability to speak clearly, sagging face muscles, paralysis of body parts,
and so on.
If there is trauma to the neck or
back so that the person can’t move their limbs.
If there has been head trauma with a
possible fractured skull
Some of the same issues apply to going to the Emergency Room. Emergency rooms are not meant for routine
visits. They are for emergencies
only. What qualifies as an emergency? Poisoning, fever in a newborn under three
months of age, convulsions, seizures, signs of a heart attack, severe burns,
chest pain, severe abdominal pain, or uncontrolled bleeding. There are also mental health reasons to go to
the Emergency Room, such as wanting to hurt oneself or others.
It can be difficult to decide whether to call an ambulance or drive
someone to the hospital. Call an
ambulance if the problem is life-threatening, if it is dangerous to the patient
to move them, if driving would cause a significant delay in their treatment, or
if they immediately need the skills and equipment that ambulance personnel
would have.
There are places called urgent care centers which are usually open for
more hours than a regular doctor’s office and which may be able to see you on
the spur of the moment. These are for
symptoms that are not life threatening but cannot wait until you can get an
appointment with your family doctor. You can call and set up an appointment or
simply walk in. Cities also often have urgent medical teams that will actually
come to your home. Check with your
insurance company to see if this service is covered and the name of such a
service in your city.
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