You can be your own best health advocate in accessing and navigating the healthcare system.
Accessing Healthcare
It is important that you are able to access the medical services and care that you need when you need it. Health insurance coverage is one of the most important determinants of your access to health care. If you don’t have insurance coverage, there are low cost or sliding-scale clinics that offer health care services. If you have insurance coverage, learn more about your coverage. Being your own health advocate also means selecting a healthcare provider who is a good fit for you.
There are many resources and services that you can use to access medical care even if you don’t have insurance. Nevada 211 is a program in Nevada that helps Nevadans connect with the services they need. You can dial 211 for information on low cost and free clinics offering medical services. You can also try searching the web using these common search terms to locate free and/or sliding clinics: Income Based Clinics, Free Medical Clinics in Nevada, Low-Cost Clinics, and Affordable Medical and Dental Clinics. Here are also some resources that you can use to help you locate free or sliding clinics and affordable insurance plans:
Health Resources and Services Administration (HRSA) Warehouse
https://www.healthcare.gov/community-health-centers/
Needy Meds – Free, Low-Cost, or Sliding Scale Clinics in Nevada
https://www.needymeds.org/medical_clinics.taf?_function=state&state=NV
Clinic Directory – Nevada Health and Medical Clinics
https://www.clinicdirectory.org/state/nevada.html
Free Clinic Directory – Nevada Free Clinics and Community HealthCenters
https://freeclinicdirectory.org/nevada_care.html
Nevada’s Free and Low Cost Mental Health Services
https://cannondisability.com/nevadas-free-and-low-cost-mental-health-services/
Nevada Health Link – online health insurance market place
https://www.nevadahealthlink.com/
If you have insurance, it is a good idea to get to know your insurance plan and some of the common medical terms. Your insurance company should have people that can help you better understand your plan. Give them a call and have them help you understand. Here are some questions you can ask (11)
- What providers can I see?
- Is it required to visit a primary doctor first before seeing a specialist?
- Is there a limitation on the number of visits I am allowed?
- How much will I pay before the plan starts to help (deductible)?
- How much will I pay each month (monthly premium)?
- How much will I pay to see my doctor, visit urgent care, go to the emergency room or fill prescriptions (copays)?
- What is the cost to see a doctor who is not covered by this coverage plan (out-of-network)?
- Are there covered urgent care clinics or emergency rooms in my area?
- Which pharmacies are in-network?
Familiarizing yourself with the common medical insurance terms can also be helpful as you access the healthcare system. You can find some of these common terms listed on this page.
Choosing a health care provider who is a good fit for you is one of the most important decisions you will make about your healthcare. Finding a provider you can trust and work with may help you feel more comfortable to share your health concerns, to discuss sensitive topics, and be more confident about the care you are receiving. When selecting a provider, think about your health care needs and what is important to you.
These are some questions that you can ask yourself when searching for a health care provider who meets your needs and preferences (7):
- Does the health care provider have experience treating my medical conditions?
- What education, training, and specialties does the health care provider have?Is the health care provider affiliated with a specific hospital system or “network”?
- Is the sex, race, or religion of the health care provider important to me?
- Does the health care provider or someone in the office speak my primary language? If not, does the healthcare facility offer language translation services I can use?
- Does the healthcare facility have the accommodations I need? (Language services, building access, virtual visits)?
- Are there any patient satisfaction reviews online for the health care provider?
The Indian Health Service (IHS) may be one great option for you if you are a federally recognized American Indian or Alaska Native. IHS provides free healthcare to American Indians and Alaska Natives at IHS-ran facilities.
If you are unsure of whether you are eligible to receive care from IHS, you can read the Indian Health Manual Part 2 Chapter 1. Or, contact your local health facility for specific questions.
Those who do not live near an IHS facility may be able to receive care from a non-IHS provider through the IHS Purchased/Referred Care (PRC) Program. This program is available as a last resort for those who are not covered by any other health insurance and do not reside near an IHS facility. Patients must meet certain requirements, including medical priority and IHS eliglibility. Read more about the PRC Program.
You can find a complete list of all IHS facilities by downloading the excel file in the IHS Locations website. Below are instructions for downloading and filtering the document to show you all facilities available in Nevada.
Nevada Urban Indians Inc. is another wonderful resource for American Indians and Alaska Natives living in Northern Nevada. Their services are open to everyone regardless of federal recognition of tribe affiliation. Nevada Urban Indians Inc. offers medical clinic services, mental health support, and victim services. They accept Medicare and Medicaid, as well as offer their own Sliding Fee Scale. For more information, visit the Nevada Urban Indians Inc. website or call them at 775-788-7600.
At Your Health Care Visit
During your visit to the healthcare facility for your appointment, you will have the chance to see a heath care provider with whom you can discuss your health concerns. You can make the most of your healthcare visit by being your very own best health advocate.
A positive health care provider-patient relationship is founded on trust and respect. When you seek medical care, your health care provider is to tend to your medical needs with empathy and care (12). The health care provider has a responsibility to you to deliver quality care that meets your needs and preferences. Your health care provider should actively and attentively listen to your concerns and clearly explain your diagnosis and treatment options. In making decisions about treatment options or how you would like to proceed, your health care provider should respect your values and preferences.
When you arrive at the healthcare facility, you will most likely be asked to complete some forms with questions about your personal information, medical history, reason for the appointment, and insurance coverage information. Be sure to bring with you all of the documents you will need to complete these forms. While filing out your form, be sure to ask the staff to clarify any questions you are not sure how to answer and unclear terms, such as technical and legal language. Some providers may give you the option to complete the required forms ahead of time.
Your health care provider is there to help address your health concerns. To effectively use your time with your health care provider, you ca openly express your health concerns and symptoms, ask questions about anything you do not understand or would like clarification on, and express your preferences for treatment options (7). Also, if a health care provider or staff ask you to do things after the visit that you won’t be able to do, it is ok to tell them. You can ask for help or tell them your challenges so maybe they can suggest something else.
- If you need treatment for a medical condition, ask about your options. You can ask the following questions (10)
- What are the treatment choices?
- What are the benefits and risks of each treatment?
- How might the treatment affect my life?
- Why is it important that I follow the treatment plan?
- What might happen if I do not get treatment?
- If your healthcare provider recommends a procedure or surgery, you can ask these follow-up questions (10)
- Why is it being done?
- What does it involve?
- What do I need to do to get ready?
- What should I expect after the test, procedure, or surgery?
- What are the side effects?
- How will I found out the results
- How long will it take to recover?
- Ask questions about your prescription medication(s)
- What is the brand and generic name of the drug?
- What is the cost associated with it?
- When should I take the drug?
Unfortunately, there may be times when you encounter an unpleasant or unethical experience during your healthcare visit. You may have been mistreated, received poor quality care, or encountered an unethical practice by your health care provider. In these instances, you have the option to file a complaint, so that your concerns are heard and acted upon (5).
To file a complaint, the first step is to find out where and/or to whom you can file your complaint. In some cases, you may need to talk to the hospital administrator, the state licensing board, or the health care provider directly. A complaint may be filed online directly on the institution’s website or a separate form may need to be submitted. Here are some resources that can assist you in the process of filing a complaint.
- Nevada State Board of Medical Examiners Board – https://medboard.nv.gov/
- Your Insurance Provider
- If your provider is Medicaid, you can contact Medicaid
- Nevada Department of Health and Human Services Nevada Division of Public and Behavioral Health (DPBH) – https://dpbh.nv.gov/Reg/HealthFacilities/dta/Complaints/Health_Facilities_-_Complaints/
- https://mypatientrights.org/
After your Healthcare Visit
After your appointment with your health care provider, remember that there may be some follow-up actions that you will need to take to ensure that your prescriptions have been sent to your choice of pharmacy.
If your health care provider has prescribed you any medication, check with the healthcare staff about the status of your prescription and if it has been sent to your preferred pharmacy for pickup. Also, if your health care provider has referred you to a specialist, check with the front desk staff for the status and any information you will need about the referral. Lastly, before leaving the facility, schedule any follow-up appointments that your provider may have requested.
If your health care provider tells you that you have a medical condition, use reliable resources to learn as much about the condition as you can. The more you know about it, the better informed you will be about treatment plans your health care provider recommends. You will also be able to make informed decisions about treatment options presented to you.
Here are some reliable resources that you can use for health related information:
- Center for Disease Control and Prevention (CDC) – cdc.gov
- Medline Plus – medlineplus.gov
- PubMed Central – ncbi.nlm.nih.gov
- U.S. Department of Health and Human Services – health.gov
- U.S. Food and Drug Administration – fda.gov
If your current treatment plan is not working, contact your health care provider’s office to schedule a follow-up appointment. Telehealth or other forms of virtual care may also be available. You can discuss your health concerns, your symptoms, and alternative treatment options at your follow-up visit with your health care provider.
Your health matters! To better understand your health condition and make informed health decisions, you may decide to seek a second opinion from a different health care provider. Sometimes, if you are not feeling comfortable with your health care provider’s diagnosis, the treatment plan or need more input, it may be worthwhile to see another health care provider for a second opinion. Even if your health care provider is a well-known specialist, a second opinion might still be useful, especially when surgery is recommended, when the diagnosis or treatment is unclear, and you want some peace of mind (13). The process of seeking a second opinion can be as simple as asking your primary care provider for a referral to a different provider than the one you were referred to previously.
Common Medical Insurance Terms (4, 5, 6)
Healthcare
The system or industry that offers access to medical care and services. It also refers to the set of medical services provided by an institution or an organization.
Health Care
Refers to individuals and groups who deliver medical care and actions they take to maintain, restore or improve physical, mental, or emotional well-being.
In-Network Provider or Preferred Provider
A health care professional, hospital, or pharmacy that is part of a health plan’s network of preferred providers.
Out of Network Provider
A health care professional, hospital, or pharmacy that is not part of a health plan’s network of providers. You will generally pay more for medical services received from out-of-network provider.
Deductible
The agreed amount you are responsible to pay each year to cover eligible medical expenses before your insurance policy starts paying.
Co-insurance
This is the amount the patient pays to share the cost of covered medical services after the deductible has been paid.
Co-payment
The fixed amount or the flat fee that you must pay out-of-pocket for certain medical expenses at each health care visit, while your insurance company pays the rest.
Premium
The monthly amount you or your employer pays for your insurance coverage.
Claim
A request made by the patient or the patient’s health care provider for the insurance company to pay for medical services.
Individual health insurance
A health insurance coverage plan purchased by individuals to cover themselves and their families.
Group health insurance
A health insurance coverage plan that is offered by an employer or other organization and covers the individuals in that group and their dependents under a single policy.
Sliding-Scale Clinics
Clinics that adjust the amount eligible patients pays for services based on the patient’s ability to pay.
- How to be a better self-advocate at doctor appointments. (2021, July 2). Real Simple. https://www.realsimple.com/health/preventative-health/self-advocacy-at-doctor-appointments
- How to speak up for better medical care. (n.d.). WebMD. https://www.webmd.com/healthy-aging/aging-health-advocate
- Be your own health advocate: why it’s important & how to do it well. (n.d.). United States of Health Care. https://unitedstatesofhealthcare.com/why-is-it-important-to-be-your-own-health-advocate/
- Glossary of billing terms. (n.d.). Dignity Health | Hello humankindness. https://www.dignityhealth.org/las-vegas/patients-and-visitors/for-patients/billing-and-payment/glossary-of-billing-terms
- Systemedic. (2020, September 15). Common medical billing terms you should understand. Health Insurance Claims Advocate. https://get-meducated.com/2020/07/common-medical-billing-terms-you-should-understand/
- WPS Health Insurance and WPS Health Plan. (n.d.). Common Health Insurance Terms and Definitions. https://www.wpshealth.com/resources/customer-resources/health-insurance-terminology.shtml
- Tips to help you advocate for your health. (2022, March 7). Verywell Health. https://www.verywellhealth.com/tips-to-help-you-advocate-for-your-health-5219442#toc-find-the-right-healthcare-professional
- Just a moment… (n.d.). Just a moment… https://patientengagementhit.com/news/patient-centered-care-lacking-for-minorities-low-income-patients
- Patient advocacy engagement toolkit | Immune deficiency Foundation. (n.d.). Immune Deficiency Foundation |. https://primaryimmune.org/patient-advocacy-engagement-toolkit
- Making the most of your health care visit. The American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/faqs/making-the-most-of-your-health-care-visit
- Health Partners. (n.d.). Picking a Health Insurance Plan: Top 10 Questions to Ask. https://www.healthpartners.com/blog/10-questions-to-ask-when-picking-a-plan/
- Smith, Y. (2019, June 20) Doctor-Patient Relationship. News Medical Life Sciences. https://www.news-medical.net/health/DoctorPatient-Relationship.aspx
- Katelle, K. (2020, January 15) Can a Second Opinion Make a Difference? https://www.yalemedicine.org/news/second-opinions#:~:text=%E2%80%9CA%20second%20opinion%20is%20most,where%20cases%20may%20be%20presented.