Your healthcare providers

Dealing With Your Healthcare Providers

“There’s never enough time.” “My doctor doesn’t listen to me”. “All they do is type at the computer.”

You and your healthcare provider probably see things differently. And that’s OK. It’s expected that you will have different points of view. By talking to each other, you can overcome these differences and work towards a common goal—taking care of YOU.  We created PainApp to help do this.

Not enough time with your provider

• Most providers have little control over their schedule.
• How much time they can spend with you depends on how heavily their schedule is booked.
  • Someone scheduled before you could have been very ill and needed more time.
• Patients who arrive late can back up the entire schedule.
• Be on time. Try to arrive 15 minutes early, allow time for traffic, parking, etc.
• It’s a common practice for 2 people to be scheduled at the same time slot in case of no-shows (just like the airlines do). First come, first served.
• Most providers are trying to do the best they can. Your understanding will be appreciated.
• Sometimes patients don’t understand why their provider is running late.
• Being the first patient of the day makes it more likely that you will have adequate time with your provider.
• Even it seems like there is not enough time, it’s important for you to ask for the care that you need.
• Knowing that you might not get all of your questions answered, listing your concerns by what’s most important to you will help you get the most out of the visit.

Watch a short video.

Rules that providers must follow:

• Providers need to follow clinical guidelines (or rules) within the insurance and hospital system.
• Providers can’t change the system and they may be penalized if they don’t follow the rules.
• Sometimes this restricts the treatments or tests they can offer.
• Extra paperwork may be needed for exceptions to the system. These are sometimes called pre-authorizations or pre-approvals. Your provider needs to fill out additional detailed forms to approve your case.
• The more detailed the information you provide to help your doctor complete these forms, the more likely your requested procedure, treatment, or exception will be approved.
• If you have a copy of the form you need completed, the more you can fill out your section, the better. Look over the doctor’s section and gather information to help them fill out their part but don’t fill out their part of the form.
• These rules are there for a reason. They are meant to improve quality of care and reduce medical errors and protect you.
  • For example, sometimes people need to complete a trial of physical therapy (PT) before they can try other treatments.
• If the rules are not followed, the insurance company will not pay for the procedure, test, or medicine and you get stuck with the bill.
• If this happens, it puts more stress on you.
• You must prepare for your visit by being clear about what you tried in the past. This App will help you with this task.

Be clear about treatments that didn’t work

If you are asked to try a treatment that you believe will not help, tell your doctor why.

• The rules require clear documentation in order to skip a treatment that has been determined to be necessary. If you can explain why your case is an exception to the rule and help the doctor document this, that will improve your chances of approval. Without strong documentation, it is very difficult to bypass the rules.
• Be prepared to give your provider specific information about required treatments that you’ve already tried but didn’t work, including:
  • Who ordered it and why
  • Where and when it was started
  • Wow long you tried it
  • What happened (include documentation or paperwork to back this up)
• Note: if a required section is left blank, the form will be rejected.
• Click here to see some examples of correctly completed forms. “preapproval forms‘ here?

Conflicts about medical tests 

• Patients and providers don’t always agree on when a medical test is needed.
• Providers should order a medical test only if it will help find the right treatment.
• For many conditions, CT or MRI scans are not helpful and can even be misleading. Abnormalities that are neither health risks nor related to the pain can show up on these scans and can lead to more unnecessary tests.
• Certain tests can make some chronic conditions more painful (such as hypersensitivity to touch, needles, or being in an awkward position for too long).
• When a medical test is ordered, don’t be afraid to ask questions:
  • Why is this being ordered?
  • What do you expect to learn from this test?
  • Will this test change my treatment plan?
  • Are there any risks to the test (like radiation exposure?)