0:05

Hi, this is Liz Craven. Welcome

0:08

to Sage aging. This

0:10

is your podcast for understanding

0:12

the aging and caregiving journey and

0:15

connecting to the information and resources

0:17

that will make your experience better.

0:20

Before we dive in, let me remind

0:22

you that you can find all Sage aging

0:24

episodes. The S aging elder

0:26

care guide, and much [email protected].

0:35

Hello and welcome everyone. Thanks

0:37

so much for taking the time to hang

0:39

out with me a little bit today. I

0:42

promise you that I will make it well

0:44

worth your while. Today's topic

0:46

is a good one. And there's a lot of

0:48

information to cover so much

0:51

information that I decided to

0:53

split this episode into two

0:55

episodes. So in this episode,

0:58

we'll have part one of our topic,

1:00

which is. Acing your next

1:02

doctor's appointment. And in part one,

1:05

we're gonna cover all of those things that you should

1:07

do to prepare before

1:09

you go to your doctor's appointment. And

1:11

in the next episode, we

1:14

will go over all of the things that

1:16

you should be aware of and your

1:19

responsibilities to make sure that

1:21

the experience you have during your

1:23

visit is a good one. So

1:26

that's a lot to cover. There

1:28

are a lot of good things that you can learn from this

1:30

conversation. I'm so glad you're here to take

1:32

advantage of that. What we hope to do

1:34

is give you some tips and some tools,

1:37

some awareness and education. I've

1:39

got a checklist that I'm making for you also,

1:42

and those things are gonna help you gain a little

1:44

bit of control over how you experience

1:46

your visits with your medical providers.

1:49

It's no secret that our doctors are

1:51

busy people. They have all

1:53

kinds of things going on in their office every

1:55

day. And though they do

1:58

have a lot of responsibility in making

2:00

sure that our experiences are good ones.

2:02

We can guarantee that our experience will

2:04

be a good one. If we take care of those

2:07

responsibilities ourselves, in some instances,

2:10

it's really hard for them to make sure that

2:12

everything is covered. And so if

2:14

you will take control of that, every

2:16

time you go see the doctor you'll

2:19

have better health outcomes and

2:21

better experiences when you have those visits.

2:24

So that's what we're gonna talk about today. And

2:26

joining me for this conversation is

2:29

Sandra Washington. She's

2:31

an incredible lady. We met on

2:33

clubhouse a while back and I

2:35

was immediately taken by

2:37

her efforts as a patient advocate.

2:40

So that is what her profession is.

2:42

She is a patient advocate. She

2:44

is an author. She's a healthcare

2:46

speaker. She's a senior subject

2:49

matter on patient advocacy and

2:51

patient empowerment. And

2:54

she has a wealth of knowledge and information

2:57

and experience that she can share with us

2:59

today. So welcome to the

3:01

podcast, Sandra. I am so excited

3:03

to have.

3:05

Thank you so much, Liz, I'm certainly

3:07

excited to be here. You know,

3:09

I told you when we first

3:11

met, if there's a passion in my

3:14

heart, that passion is to be the

3:16

best independent board certified

3:18

patient advocate that I can be so

3:20

that I can help all people

3:23

as. Especially my loving seniors,

3:25

because without our senior population,

3:28

this world would not be where it

3:30

is. And so therefore I

3:32

have a special soft spot in my heart

3:34

for them and making sure that they

3:36

get everything that they deserve

3:39

and all the treatment that they receive

3:41

from their doctor's office is

3:43

of course of the optimal healthcare.

3:46

It's all about loving on our seniors

3:48

to make sure that they're taken care of cause after

3:50

all they took care of all of us.

3:52

They sure did. That really does encapsulate

3:55

why I was so drawn to you in the first

3:57

place. For those who are not aware, clubhouse

4:00

is another social media platform.

4:02

It's a place where you can go in and have live

4:05

conversations. And Sandra

4:07

joined me a number of times

4:10

for some Saturday morning talks that we

4:12

did just to spill

4:14

the information out to people, just another

4:16

avenue, kind of like a podcast right

4:19

here that we would go in and just

4:21

let people ask us questions. And

4:23

to the best of our ability, we would lead them

4:25

to the answers and additional resources

4:28

where they could dig deeper and learn. And

4:30

so I think we really connected in

4:32

that way, because we both have a heart

4:35

for that kind of service. We want

4:37

to share what we know

4:39

to empower other people. To

4:41

have a better experience. In my case,

4:44

I wanna empower people to have better caregiving

4:47

and aging experiences. And I

4:49

love that the advocacy part

4:51

that you can bring to the table is

4:54

just such a benefit.

4:55

Well, thank you so much. It benefits

4:57

me to know that I can turn on the TV

4:59

and hear a story about a senior that

5:01

went for whatever medical treatment and

5:04

got such good treatment that they

5:06

actually had to broadcast it. And like I said,

5:09

our senior population is one of those

5:11

groups that seemed to somehow another,

5:14

be always at the beck

5:16

and call of not understanding and no

5:18

one being able to help them.

5:20

Well, we're gonna get a little deeper into that,

5:22

but first we're gonna do something

5:24

just a little bit fun. I would

5:26

love for listeners to be able to

5:28

connect to you in a little bit of a personal

5:31

way. So why don't you give me

5:33

two words that you would say describe

5:35

you.

5:36

Dedicated and passionate.

5:38

I could have chosen those. You're absolutely

5:41

right. Where does all

5:43

that dedication and passion come

5:45

from? Is that something that was instilled in

5:47

you by one of your parents

5:49

or a grandparent? Where did that come

5:51

from?

5:52

You know, I want to actually

5:55

give credit and thank you so much for asking

5:57

that question. I wanna actually give

5:59

credit to both my maternal

6:01

grandmother and my paternal

6:04

grandmother. I was

6:06

named after both of them, believe it or not.

6:08

My maternal grandmother's name

6:11

was actually, Kristomer Louise,

6:13

may she continue resting in heaven. My

6:16

paternal grandmother's name was Henrietta

6:18

Louise. And may she forever

6:20

continue resting in heaven. I

6:22

take that from them. My fraternal

6:25

grandmother passed away when I was yet,

6:27

but a teen. My maternal

6:29

grandmother, she lived till I was like in

6:31

my twenties and thirties, the stories

6:34

that I heard about my paternal

6:37

grandmother, the love that she had instilled

6:39

in her for her family and her community,

6:42

my maternal grandmother, she was a geriatric

6:45

nurse. She was a geriatric CNA.

6:48

and sometimes listening to

6:50

the stories as a child that she would

6:52

tell about the heartaches that she

6:54

would encounter in her work actually

6:57

drove it within me.

6:58

I love that. Sometimes I get very

7:00

short answers to my questions and that

7:02

was so beautiful. And I do feel

7:05

that'll help people connect to you a little bit

7:07

because we all have that kind of story about somebody

7:10

important in our life, don't we?

7:12

Yes, we should. And it's never, ever

7:14

too late to get someone

7:16

like that when we're talking about our

7:18

older Americans, right? It's

7:20

not too late. They can always outreach

7:22

organizations such as yours through

7:24

stage agent. They can actually

7:27

have their caregiver or their grandchildren

7:29

or their children, or even themselves look

7:32

online and see what organizations

7:34

are around that the older

7:36

American population, because

7:38

when they do that it actually sets up

7:40

a community of love and a community

7:43

of care. And what that does

7:45

is it helps them remove

7:47

a lot of that stress that comes along

7:49

with just not knowing and feeling like they have

7:52

no one to turn to, to ask questions

7:54

of whenever they align themselves

7:56

with those types of, of organizations

7:58

and those types of people.

8:00

Right. And that's a great segue to kick

8:02

off our conversation about

8:05

being completely engaged.

8:07

When I say engaged, I mean,

8:10

actively participating in what happens

8:12

with, for, and to you

8:15

in your world. So whether you are

8:18

someone who is aging, someone who

8:20

is providing care, someone

8:22

who is a provider, I think

8:24

we all have our responsibility

8:27

when it comes to each of the interactions

8:29

we have in every area of our life, on a

8:31

daily basis. But the

8:33

core of the question that we want

8:35

to impress upon people today is

8:38

why is it important to

8:41

be actively engaged in

8:43

your healthcare?

8:45

You know, clothes mouths never get

8:47

fed. In no greater

8:49

place do we see that today

8:52

than in our healthcare. Closed

8:54

mouths never get fed. Patients

8:56

have rights and patients

8:59

have responsibilities. And

9:01

one of those rights that they have

9:03

is to ensure that the doctor's

9:06

talking to them in language that they

9:08

understand that they're leaving out

9:10

of that doctor's officewith

9:12

information that they understand

9:14

so that they can be compliant in

9:16

whatever the doctor says. A responsibility

9:19

that they have that goes hand in hand with that

9:22

is they have the responsibility to

9:24

speak up, speak

9:26

loud. And I'm not talking about being

9:29

boisterous when they talk, but I'm

9:31

saying be loud enough so

9:33

that what they're asking for what

9:36

they're demanding, isn't falling on

9:38

deaf ears. There's someone there that's hearing

9:40

them and someone there, that's doing something to

9:42

act on their behalf and

9:44

then speak often. That's a patient's

9:46

responsibility. The greatest

9:49

tool that any patient can

9:51

have when they go to the doctor's office

9:54

is the use of their voice.

9:56

And if your voice isn't being heard,

9:58

because you're afraid find somebody that

10:01

can speak for you. Find somebody,

10:03

a friend, a family member. My business

10:06

MediHelpz works with patients all the

10:08

time but it's always, always

10:10

important that the patient understand the

10:12

importance of their voice and that

10:14

the patient use that voice to

10:16

request and to get those

10:19

rights and responsibilities that they are

10:21

allotted.

10:23

That is such a great point. I love

10:25

the emphasis that we're placing there

10:28

because it's true. I know there

10:30

are a lot of people who

10:33

my generation included I'm gen X,

10:35

and I think we kind of ride the line

10:37

between the generations and how we

10:40

view the cultural norms, but

10:42

in my family, doctors

10:44

were to be respected and it

10:46

was almost like a parental or

10:49

an authoritative figure

10:52

in your life. And you listened to what

10:54

they said. And you took

10:56

the advice that they're giving you and you make sure

10:59

you act upon that and you follow their

11:01

rules and follow their directives.

11:03

But a lot of things

11:05

get missed that way, because first

11:08

of all, we are in a different time and place

11:10

doctors don't spend 30 or

11:12

40 minutes with you at a visit

11:14

like they used to, they can't

11:17

and they don't have that time. So typically

11:20

your average visit is gonna be 12

11:22

to 15 minutes with the doctor. And

11:24

so you have to know how to take control

11:26

of that. And like you said, you

11:28

have to speak up because

11:30

if you don't speak up. It's gonna be

11:32

another however long until you

11:34

see that provider again. And

11:36

good luck getting questions answered.

11:39

Once you leave that room.

11:41

Right. And that's so, so true. Liz,

11:44

you and I grew up in the same generation

11:46

when I was younger, we were

11:48

told let's do what the doctor is saying.

11:51

Well, that's because the doctor was actually

11:53

able to view you,

11:56

his patient, as a family

11:58

member.

11:58

Mm-hmm

11:59

He cared for you as a family

12:01

member. I remember our family doctor

12:04

coming to do the home visit because

12:06

my mom couldn't make it to the doctor's

12:08

office. She was a single mother. My dad had

12:10

passed away when I was a baby

12:13

and she couldn't make it

12:15

to the doctor sometimes. Well, he would come

12:17

by and he would do home visits.

12:20

Well that was when medicine was medicine. And

12:22

most of your audience that

12:25

listens to this podcast, they

12:27

are gonna remember those good old days

12:29

too, because that's when medicine

12:31

was medicine mm-hmm well, enter

12:34

the ACO, which is

12:36

affordable care organization. Enter that age.

12:41

And enter the fact that medicine and

12:43

healthcare is viewed not

12:46

as a empathetic ear

12:48

and viewed as everybody's a part

12:51

of the family and healthcare is

12:53

viewed as a business. Yes. So when

12:55

you flip that switch the older doctors

12:58

that worked and truly cared

13:00

about their patients. Not that there's not

13:02

younger doctors that do this, but

13:04

you had a lot of older doctors that were doing

13:07

the services for themselves.

13:09

They didn't have a clock waiting on

13:12

them if their patient needed 45,

13:14

50 a hour worth of

13:16

time, they were given that time. They weren't

13:18

rushed out of the door. Well, now

13:20

you don't have that. Unfortunately

13:23

those days are never coming back. So

13:26

you have to get used to speaking

13:28

up. And a lot of those older doctors, they

13:30

retired. So you have a lot of younger

13:33

doctors now who came in under a whole

13:35

different system who

13:37

wanna care, who wanna love on

13:39

their patients as much as they can and want

13:41

the best for their patients, but because

13:43

healthcare is now branded as a

13:46

business, They can't do it.

13:48

Yes. Their hands are tied. Thank you for

13:51

bringing that point to the forefront.

13:53

We are not here today to

13:56

demonize the medical professionals

13:58

because we know they are working within

14:01

the system. That has been

14:03

presented to them. They have to do what they have

14:05

to do, and their hands are often

14:07

tied by the insurance

14:10

companies and other regulations.

14:12

And the fact that they have to answer

14:14

to shareholders many times, there

14:16

are a lot of things at play that

14:19

shouldn't be at play in healthcare,

14:21

but this is where we are. And

14:24

so our point here today

14:26

is to help you to help

14:28

your medical providers by

14:30

being the most prepared

14:32

that you can be. And by being

14:35

organized and by knowing

14:38

different things that you can do to help this process

14:40

go more smoothly. So

14:42

all the love to the medical providers

14:45

who are taking care of people. This

14:47

is about helping you to be more

14:49

engaged in the process and

14:51

to have a little more control

14:53

That is in fact true. It's called patient

14:56

empowerment. And that's exactly

14:58

what this called today is about once

15:00

again, it's not about bashing, right? Right.

15:02

Because we have to work together. We

15:05

as the patient have to do

15:08

our part and make sure that

15:10

we're following our rights and responsibilities.

15:13

And the doctors on the other hand, do their

15:15

part in patient centered care.

15:18

The patient is the one that controls

15:20

that care. They will wanna work with

15:22

the patient to make sure that optimal

15:24

healthcare is received and that's

15:26

for all healthcare professions.

15:29

Absolutely. So the next

15:31

point that we're gonna cover this is gonna

15:33

be some of the juiciest meat

15:35

of this conversation, because

15:38

we are going to talk to you about

15:40

how to prepare yourself

15:43

or a loved one for your doctor's

15:45

appointment. This will help you to

15:47

get the most out of every visit

15:49

that you experience. So

15:52

I expect we'll spend a few minutes on this

15:54

because to be an

15:56

engaged patient is

15:58

to have a more successful

16:01

and healthier outcome. So

16:03

what would you say are the

16:05

most important ways that people

16:07

can prepare themselves

16:09

for a doctor's visit?

16:11

One of the first things that patients

16:13

can do is. Write

16:16

down the questions that

16:18

you wanna ask your doctor.

16:20

Now I'm not talking about writing them down on some

16:22

scribble piece of paper and throwing them somewhere,

16:25

and then you can't find it or their notes are

16:27

not conclusive, which is one

16:29

reason why I wrote the personal health

16:31

planner and journal is because they don't

16:33

have a lot of time to answer those questions,

16:36

or they don't have a lot of time to actually

16:38

be with the patient while they're going

16:40

through everything. But if the patient has

16:42

a question and they have it written down

16:45

and they say, Hey, doc, what about this? Right.

16:47

It's right there in front of them. They can then

16:50

notate it. Anything that they don't

16:52

have an answer to at the end of the day,

16:54

whoever their caregiver is, or even

16:57

themselves, they can go onto their

16:59

patient portal, which is where

17:01

their EHRS emergency electronic

17:03

health record system. That's

17:05

where their medical

17:07

information is kept mm-hmm

17:10

so they need to know where's my electronic

17:13

health record system, AKA

17:15

patient portal? Where is

17:17

my patient portal? How can I

17:19

find it? Because if you go to the

17:21

doctor's office prepared and

17:23

say you have 20 questions, and the doctor's

17:26

only able to answer 10. Well

17:28

then the other 10, you put in

17:30

your patient portal and send

17:32

it to the doctor so that he can respond

17:34

to it. Doctors have timeframes

17:37

and when they're supposed to actually respond to

17:39

questions that they give from their patients,

17:41

but the doctors can respond to those without

17:44

them being in the office. So two

17:46

takeaways from what I just said

17:48

is always make sure you

17:50

have your questions written down.

17:53

Preparation is key. So

17:55

when you go in prepared and

17:57

knowing, okay, well, if I can't get these questions,

18:00

I'll go put 'em in my patient portal.

18:02

That's step number two for patients,

18:04

make sure you know where

18:07

your electronic health record system

18:09

is. Make sure you or

18:12

your family member or your caregiver,

18:14

make sure that someone knows

18:16

how to access your records so that

18:19

you have your records with you at all

18:21

times.

18:22

That is really good stuff. Okay.

18:25

So what's next.

18:27

The other thing that you wanna do when

18:29

you go to the doctor's office is you

18:31

also wanna make sure what

18:34

insurance, you have. Many

18:37

people, especially in our senior

18:39

population, they have Medicare,

18:42

a few have Medicare and Medicaid,

18:45

a few have Medicare Medicaid, and

18:47

they have insurance through their employer.

18:50

They're retired now, but they have

18:52

retiree benefits. Make

18:54

sure when you go to the doctor's office,

18:57

that, you know, what kind of insurance you have

18:59

so that you don't get a bill from

19:02

something that you didn't pay or that maybe

19:04

the insurance company didn't pay

19:06

it. And now they're saying you're responsible for

19:08

it. Maybe that doctor is outta

19:10

network. So that's three and four.

19:13

Make sure you know, what type of insurance

19:15

you have the doctor's office. A

19:17

lot of times is not gonna know

19:19

what type of insurance you have. They're

19:21

not gonna know that you have

19:24

two other insurances or another

19:26

insurance. They're not gonna know that

19:28

information because they don't have

19:30

the time to ask you. But in addition

19:33

to that, that's not their role. That's what

19:35

they have an administrative staff for.

19:37

But what happens a lot of times is that

19:39

when I say administrative staff, I mean,

19:42

whoever's at the doctor's office, whether

19:44

it's a medical assistant, whether they've hired

19:46

an outside company to do it, whoever's

19:49

scheduling your appointment. When

19:52

you schedule your appointment,

19:55

make sure you

19:57

are actually giving them all

19:59

of your information, because

20:01

there are too many times when an older

20:04

American goes to the doctor's office,

20:06

they just present with one insurance.

20:08

That insurance is billed and there's

20:11

a balance. That balance is

20:13

then billed to the patient. Well,

20:15

guess what, if you have two, three insurances,

20:18

you shouldn't be seeing it. They should be billing

20:20

the other insurance, but many times

20:22

it doesn't happen. So please,

20:24

please, please make sure you know

20:27

what insurance you have. I had

20:29

a conversation with someone and I asked

20:31

them, I said, well, what insurance you have? She

20:33

says Medicare. And I'm like, well, what kind

20:35

of Medicare? She's like, I

20:38

don't know. I, I just know I have Medicare

20:40

and I'm like, but you have to know, because

20:43

now there's traditional Medicare

20:46

where they pay 80%

20:48

and you pay 20% or

20:50

there's Medicare advantage. There's

20:52

a difference. And there's a difference in how you

20:54

are billed when you go to the doctor's office.

20:57

So you really need to know

20:59

what insurance you have. And for those who

21:01

are listening that do not know,

21:03

look and see what you have as

21:05

far as your Medicare coverage,

21:08

because there's Medicare plans that

21:10

actually offer different things.

21:13

So you wanna make sure what your plan

21:15

covers, but you also wanna make sure

21:17

that you're giving it information to the doctor's

21:19

office so that when you go, they know

21:22

who it is, they should bill and how it is

21:24

they should bill it.

21:25

That is such a good point.

21:28

I can back that up with an experience,

21:30

not my own, but a very

21:32

good friend of mine. her husband

21:34

has had a lot of issues over

21:37

the last year. And so they've seen a

21:39

lot of doctors and

21:42

often the doctor will say,

21:44

I need to send this to the lab

21:46

for tests and whatever and the

21:50

patient assumes that

21:52

they're gonna send that sample to

21:54

someone within their network, but that's

21:56

not what always happens. Typically a

21:59

medical office is gonna have certain people

22:01

that they tend to work with more. You

22:03

have the right to choose.

22:06

Who that sample goes to, but

22:08

if you don't communicate that to

22:11

your doctor's office and be aware

22:13

on your own that these are

22:15

the labs that are in my network, then

22:17

that could become a problem and you are gonna

22:19

get lots of bills.

22:21

right. And sadly, it's not just

22:23

happening to those in our senior

22:26

population. Sadly, it happens

22:28

to even younger people where they go

22:30

to the doctor. and the

22:32

doctor says, okay, well, I want you to go to lab

22:34

X, Y, Z. And they go to

22:36

a lab X, Y, Z, and then they get a bill

22:39

and they're like, well, why did I get this bill? How

22:41

come I have this bill? Well, there's

22:43

two ways that that's handled. Right? You

22:46

can always call because when

22:48

you are in network, doctor,

22:51

sends you to a place

22:53

to get services rendered. And

22:56

then you find out that that doctor

22:58

is not in that network. You

23:01

can call the insurance company and

23:03

file an appeal. What

23:05

that appeal will do was actually,

23:07

and a lot of times see that

23:09

you only went to that doctor

23:11

because your in-network doctor told you to

23:14

go there. Right. So they'll

23:16

go ahead and pay it at the in network

23:18

rate. Many people don't realize that

23:20

they go, oh, their in-network doctor

23:22

sent them there. And they went

23:25

thinking that the end network doctor, where they

23:27

sent them to is also in network

23:29

and they're not supposed to do that. Right.

23:33

But if you don't tell them, for instance,

23:35

with my insurance for

23:38

a long time, my doctor wanted to send me

23:40

to the lab that actually

23:42

belongs to the medical group

23:44

that I'm part of only my insurance

23:47

company doesn't cover them. So

23:50

I'm like, yeah, I'm not going there. so

23:53

he was actually able to get me where I needed to

23:55

go, but how many people would go

23:57

to the doctor's office? They get something they don't

23:59

know to tell 'em that this is what insurance

24:01

I have, and they're sent to the wrong place

24:03

by an in-network doctor, then the insurance

24:06

company, a lot of times will actually go ahead

24:08

and pay it at the in network

24:10

rate because it was their doctor,

24:13

which is why doctors signed contracts with

24:16

insurance companies, cuz they've

24:18

set up the rules and regulations. But

24:20

when they're sent there by the in network

24:22

doctor they'll get that bill paid.

24:24

But a lot of times they don't know

24:26

it.

24:27

And it's a bit unrealistic for us

24:29

to expect every doctor's office, because

24:32

they work with multiple insurance

24:34

plans to get it right every single time.

24:36

And that's another reason that we as

24:38

individuals and as the patients

24:41

need to be responsible for

24:43

keeping track of all of those things on our

24:46

own.

24:46

There's a couple of things that people should.

24:49

Always know and always

24:51

have. One is you need to know the

24:53

number to your insurance companies. If

24:55

you have three insurance companies,

24:58

you need to have the numbers to all

25:00

three insurance companies somewhere where you can

25:02

write it down. So what

25:04

happen is, is when you leave the doctor's

25:06

office, and you call your insurance company

25:08

and say, well, my doctor gave me or an order

25:11

or referral to go see

25:13

Dr. Sue, can you tell

25:15

me if Dr. Sue was in my network? It's

25:18

as simple as picking up the phone and

25:20

calling and asking your insurance company,

25:23

because what their customer service reps

25:25

are paid for is to help their members and

25:27

ask the rep, Hey, is

25:30

this provider in network? And if they

25:32

tell you, no, it's not, your

25:34

next question is going to be well,

25:37

who is? So that you can get

25:39

a list and they can send you a list who's

25:42

in network that does this particular type

25:44

of service. They send you the list,

25:47

you'll then have something to go back to your doctor

25:49

and say, okay, well, this doctor you gave me this for

25:51

is not my network, but this

25:53

doctor is, can you send me here?

25:56

Or do you have a problem with me going

25:58

there? So one of the best tips

26:00

that I can give anybody is please become familiar

26:02

with what insurance you have, what

26:04

the customer service numbers are, what

26:07

their hours are. A lot of insurance companies

26:09

have round the clock agents

26:12

that answer their phone. Right? Right.

26:14

So there's a thing. Well, my daughter or

26:16

my son usually does this, but they work

26:18

till six o'clock they're usually

26:20

open because they realize that people

26:22

are gonna call at all times a day and

26:24

night. They're usually open. Not

26:26

all of them have those hours, but

26:29

a lot of them are open 24

26:31

7. So use that number

26:33

as the number it's usually on the back of your card

26:35

that says member services or customer

26:38

service so that you don't feel

26:40

like you're walking through that path alone, even

26:42

for those people that are listening that do not

26:45

have help like that, maybe their kids

26:47

live in another state, or maybe

26:49

they're like my mother who

26:53

at 91 years old says

26:56

I could do this myself. Oh,

26:58

okay, mom, I'll let you do it yourself, but

27:00

here's what you need to do so

27:02

that the instructions are clearly laid

27:04

out for what she needs to do. I

27:07

mean, of course we go behind her and make sure

27:09

that what she's doing is correct and

27:11

we're helpful to her that way. But.

27:14

You know, if you're an empowered member

27:16

and you're in this older American population

27:19

and you're empowered enough to continue to do

27:21

those things on your own. God bless

27:23

you. Please continue to do those things on

27:25

your own, but please make sure you're

27:27

writing down the information that you need to

27:30

follow in order to be able to do

27:32

it correctly.

27:33

Very good advice. We could do

27:36

an entire episode on

27:38

insurance alone. And I don't wanna

27:40

spend a lot of time here, but I do want to

27:42

mention if you are someone

27:44

who doesn't really know

27:47

what you have, as it relates to Medicare,

27:49

I would encourage you to

27:52

find your local ship office.

27:55

That is a federal program

27:57

that assist people in choosing

27:59

the right Medicare option

28:02

for them, it's different in

28:04

each state. And I

28:06

will put a link in the show notes

28:08

and in the blog post for this episode.

28:10

So that you'll have that, but I'd

28:12

encourage you to engage

28:15

there because having the right plan

28:18

makes all the difference in the world. Maybe you're

28:20

somebody who needs a no co-pay

28:22

plan. Maybe you have certain

28:24

health issues that you're dealing with,

28:26

or certain medications that you need.

28:29

These volunteers who

28:31

are intensely trained

28:33

can help match you to the right program.

28:35

So that's my tip of the day.

28:38

You're absolutely correct. When you

28:40

say reach out to the ship program,

28:43

which is the state health insurance

28:45

program you're correct in encouraging

28:47

them to do that. A lot of times what

28:50

I encounter, especially with my

28:52

older population is that

28:54

they call Medicare. And

28:58

they have a conversation with Medicare

29:00

and they get off the phone with Medicare and

29:02

they're very stressed out because they're like,

29:05

that was no help. And what

29:07

people have to realize when

29:09

you call the Medicare number, Medicare

29:12

can only be of so much help.

29:14

And that is because they can't seem

29:16

like they're actually, you know, well,

29:18

we. Blue cross better than we

29:20

like Cigna because that's actually

29:22

misguiding you. So while they wanna

29:25

help you, and while they more than

29:27

likely have their own choices of which plans

29:29

they would pick, they're unable to,

29:31

because then that actually puts

29:33

a sort of, of nepotism

29:36

mm-hmm in the whole thing. So

29:38

they give you as much as they can.

29:41

But they can't lead you directly

29:44

to what you want. Whereas with

29:46

the ship programs, the people

29:48

there can take a deep dive with

29:50

you and look to see what's

29:52

available, you know, under what

29:54

plan certain people are on medications

29:57

with the Medicare part D. All

30:00

insurances don't cover the

30:02

same medications at the same

30:04

rate. So speaking to someone

30:07

at ship or knowing a patient

30:09

advocate, knowing how to actually get a hold

30:11

of a patient advocate and work with a patient

30:13

advocate, knowing all of those things

30:15

to help you along the way is a great,

30:17

great help for you because

30:20

while they want to, they just simply

30:22

can't give you the information that they

30:24

wanna give you.

30:26

A hundred percent and Medicare is like

30:28

alphabet soup. There are so

30:30

many different pieces to it. It

30:32

would be impossible unless you

30:35

work in that arena to really

30:37

be completely familiar. And I

30:39

might mention also for those who are listening

30:41

in Florida, our ship program

30:43

is called shine. You've probably heard that before.

30:47

So again, I'm gonna have a link

30:49

that will help you no matter where you

30:51

are. In the United States to find

30:53

the program that is local to you.

30:56

Now I do wanna actually also throw

30:58

this out there because I do know that you

31:00

have people of all ages

31:02

that will be listening to the podcast

31:05

mm-hmm And this is a very, very

31:07

important tool or tip,

31:09

I should say, for

31:12

those of you who are listening, who

31:14

are not on Medicare, but

31:17

you'll soon be eligible for Medicare.

31:20

Please sign up and do what you're supposed

31:23

to be doing to make sure as far as

31:25

your doctor's care goes, please

31:27

make sure you are following

31:30

the. Deadlines that Medicare

31:32

provides to you for signing

31:34

up for Medicare. One,

31:37

if you don't do it, there's actually

31:39

a fine, that's charged against you

31:42

for not doing it. Two.

31:44

If you don't pick up Medicare plan

31:46

and you supposed to pick a Medicare plan,

31:49

a lot of times a Medicare plan will be

31:51

chosen for. Right.

31:53

If you have a Medicare plan that's chosen

31:55

for you say, you say, okay, well I wanna do

31:58

Medicare advantage. So you halfway finish

32:00

your papers and you're like, and you send them

32:02

in and say, I wanna do a Medicare advantage. And

32:04

you don't tell 'em what Medicare advantage plan

32:06

is. And you don't call to tell

32:09

them, you know, Hey, I'm I filled the

32:11

paperwork out and I now know what

32:13

Medicare advantage program I want.

32:15

A lot of times you'll be put into

32:19

plan that your doctor is

32:21

not a part of. And

32:23

that's the last thing that you want

32:25

to do is to be put in a plan,

32:28

especially if you have a chronic

32:30

illness where you're constantly seeing a doctor,

32:33

that's not on a plan that you're choosing because

32:36

you won't be able to see that doctor again, unless

32:39

you're paying full price to see him. Always,

32:42

always. When Medicare sends you

32:44

stuff and says, we need to have this back

32:46

by monday June

32:48

1st at 10 o'clock in the morning,

32:50

make sure you're putting that in the mail.

32:53

And we all know that, you know, some states

32:55

we have snail mail, so we all

32:57

know that, Hey, I need to not wait

32:59

until May 20th and send

33:01

this knowing that it's due June 1st, fill

33:04

it out. As soon as you get the information

33:06

so that you don't forget so that you're

33:08

not looking and saying, well, Dr.

33:10

Smith said, I can't come to him no more because.

33:13

I'm not, he's not on that plan so

33:15

that you're not being left out in

33:17

a cold because plenty of times

33:20

I hear people ask me okay, well, what

33:22

plan is better than the other plan? And

33:24

it's not so much, what plan is better

33:26

than the other plan is what plan

33:28

is your doctor

33:31

on, right? That's the plan that you

33:33

want. So pick up the phone for those

33:35

of you now are close to getting to Medicare

33:37

age and. Almost there and

33:40

know these papers are coming. Pick

33:42

up that phone, call your doctor's

33:44

office. Say, could you tell me

33:47

what Medicare plans you take

33:50

so that I can know to fill these papers

33:52

out correctly?

33:54

So much good advice. I knew this was

33:56

gonna be an incredible conversation.

33:58

Thank you so much. This is great,

34:00

good stuff. And don't worry. We're gonna document

34:03

all of this in one nice

34:05

post to help you all work through it, and

34:07

we'll create a checklist for you so that

34:09

you can easily follow the tips

34:12

that are being given here today. One

34:14

more thing as it relates to insurance.

34:16

We talked about this before we started

34:19

recording, and I want you to give

34:21

a very brief explanation of

34:23

what an E O B is

34:26

because it's something people all see

34:28

those three letters together, but many don't

34:30

know what that means. What is that?

34:32

An EOB is

34:34

an explanation of

34:37

benefits, never,

34:39

ever pay a bill

34:41

that you receive from a doctor's

34:44

office without having

34:46

the E O B from your

34:48

insurance company that says

34:50

how the claim was processed.

34:53

I was just helping someone and

34:56

he has a pile of bills and he's paying these

34:59

bills and I'm like, well, what are you doing? He's

35:01

like, I'm paying these bills. This stack is for what

35:03

I'm being billed. And this stack is for what I paid.

35:06

And I was like, why are you doing it? He

35:09

was like, well, that's what I have to do. And I'm like,

35:11

where's your EOB EOB. What's

35:13

the EOB? And I had to explain it

35:15

to him. I said, don't ever pay

35:17

a bill without getting your explanation

35:20

or benefits statement. First you go

35:22

to the doctor's office and the doctor's office

35:24

asks you, do you wanna pay now? Or you wanna

35:26

pay later? You wanna make

35:30

sure. That the correct

35:32

bill was built in the insurance company.

35:34

And you wanna make sure of the amount

35:37

that you owed, because if you go to an

35:39

in network or a contractor

35:42

provider, instead of bill is $200,

35:44

the contractor rate is only a hundred

35:46

dollars. All you're responsible

35:49

for is whatever your insurance

35:51

doesn't cover. Of that hundred dollars.

35:53

You're not responsible for the

35:56

$200 because they're in

35:58

network, they're contracted. They

36:00

shouldn't be charging you that that's

36:02

why you wanna wait until the insurance company pays

36:04

it and send you an explanation

36:07

of benefits on EOB, because

36:09

that's when you'll know for sure.

36:12

What it is that you owe to

36:14

the doctor's office because the insurance company

36:17

will have processed it. And even

36:19

then with the EOB points out

36:21

to you, a lot of times say you go

36:23

to a doctor's office

36:25

and you're getting a charge for a

36:28

hospital. It'll tell you whether

36:30

or not this was something that you actually had

36:32

done. And was it done at the place

36:34

that is saying that you had it done? So

36:37

EOB is your number

36:39

one. When you go to paying the

36:41

bill, you never wanna pay it without

36:43

actually receiving it. And if they haven't

36:45

received it and you're getting a bill call

36:48

insurance company, once again, your best

36:50

buds call insurance company

36:53

and ask them, say, Hey,

36:55

I got a bill from Dr. Smith

36:58

for date of service may

37:01

20th for $500.

37:04

Did you receive this? And if they

37:06

didn't receive it, they'll tell you

37:08

we never received. Let's call

37:10

the doctor's office and you can actually

37:13

ask when you call the doctor's

37:15

office so that your worries are put to bed,

37:17

you can actually ask them well, when

37:19

you call to check on this, can

37:22

I be on the phone with you? A lot

37:24

of times they'll conference you in so

37:26

that you can hear the conversation that goes

37:28

on between the insurance company, the

37:30

doctor's office, so that you'll know,

37:32

and always write down who it is you

37:35

spoke to what day it is you spoke to

37:37

him what the time is, cuz you might

37:39

need that information to

37:41

always write it down. But that

37:44

what an explanation of benefit is. Actually,

37:47

there's a book that's out

37:49

that says, never pay

37:51

the first bill. And I could not

37:53

agree with the book more, never, ever

37:56

pay the first bill, because when you do

37:58

it takes some time, one

38:00

for you to get your money back. And

38:02

two, a lot of times it just gets

38:04

held up in red tape. So you don't wanna

38:07

do that. and just one final note,

38:09

what happens a lot of times when you pay a bill

38:11

and then you come to find out, oh, I shouldn't have paid

38:14

this bill and you call a doctor's

38:16

office and say, Hey, you billing

38:18

me. $200 for

38:20

this service. I wasn't supposed

38:23

to pay it, but I paid it. Can I have

38:25

my money back? They'll tell you

38:27

that. They'll give you a credit. What

38:29

if you decide you don't wanna go to that doctor again?

38:32

What are you gonna do with my credit? No,

38:34

I want my money back so never

38:36

let them tell you that they'll put it on

38:38

a credit if that's not what you want mean,

38:41

actually ask for it and make sure you get

38:43

a refund the same way you paid

38:45

them, if that's what you want.

38:49

All right. That is where we're gonna stop

38:51

for today. And as I mentioned in

38:53

the beginning of the episode, this

38:55

is going to be a two part

38:58

series about. Acing

39:00

your next doctor's appointment. So

39:02

make sure that you're following up next time.

39:05

Next episode for part two,

39:07

we'll have that ready for you in a couple

39:09

of weeks, the best way to make

39:12

sure that you don't miss that is to

39:14

subscribe to the Sage aging podcast.

39:16

In your favorite podcast app,

39:18

you can always find the [email protected].

39:22

If you look on the front page, Find a

39:24

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39:26

and we hope that you'll subscribe. And

39:29

also we hope that you'll send us some feedback,

39:31

let us know how we're doing. Are you

39:33

enjoying the topics that we're creating for

39:36

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39:38

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39:40

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39:42

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39:44

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39:47

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39:49

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39:52

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39:57

That's all for today. Friends. Thanks for

39:59

taking the time to hang out with us today

40:01

and we'll talk real soon.