Transcript How to Access Excellent Medical Care

How to Access Excellent
Medical Care
CYNTHIA MACLUSKIE
Primary Care Doctor Is King
 Medicaid/EPSDT requires that the primary care
physician request the treatment including medical
interventions , ABA therapy with BCBA supervision,
speech, physical therapy, and occupational therapy.
Using Your Primary Care Physician Effectively
 It is crucial to find a physician who you can work
with closely.
 Update the physician on the therapies that are
working and why. Ensure all reports from all other
doctors and therapists are going to the primary care
physician.
How to Develop a Good
Relationship with Your Primary
Care Physician

See your physician consistently

Don’t call-make an appointment

Be respectful of their time

Let the scheduler know if it will be a long appointment
Why
bother?
 If you have AHCCCS you will
need your primary care doctor to
fight for your child to see a
specialist.
 If you need an expensive
intervention the doctor will fight
with the medical director of your
insurance or AHCCCS.
 If you need to go to a hearing you
will need a letter of medical
necessity from your child’s doctor.
 The physician is your advocate
inside the medical system.
 You may need your physician to
testify on your child’s behalf.
What if I hate my child’s
doctor?
•A S K A F R I E N D F O R A R E C O M M E N D A T I O N
•C O N S I D E R “ D A T I N G ” A F E W D O C T O R S
•C O N S I D E R I F W H A T Y O U A R E L O O K I N G F O R I S
REALISTIC
Requesting A Medical Service
WHAT TO DO BEFORE THE APPOINTMENT
Research Your Concerns
•
Make a list of all medicines and supplements your child is currently taking
including dosage.
•
Keep a health journal. Summarize it in a one page bullet point sheet so the
doctor has an accurate health history. Be sure to summarize concisely so that
you do not take more than 2 to 5 minutes.
•
Make a list of reasons why you want to see a particular specialist or test.
Make this concise so that you can use your time wisely.
Don’t
Forget!
 Your insurance card
 Any paperwork requested
 Any records that the doctor needs
 A list of questions
 A written goal of what you want
out of the appointment
Consider the Following:
•
Arrange for a respite worker, friend or spouse to attend
the appointment with you. This way one adult is in
charge of the child/children and you can pay complete
attention to the doctor.
•
If it will be a complicated appointment ask if you may
record the appointment so that you can review later.
At The Appointment
 Be concise and direct.
 Be an active participant in the appointment.
 Make sure to be unemotional.
 When the doctor asks you how your child is doing
give a short list of your concerns.
Ask
Detailed
Questions
Why do I need it?
 Will my insurance pay for it?
 What does the test measure?
 How accurate is the test?
 How is the test preformed and how
much discomfort will there be?
 How should I prepare for the test?
 When will I get the results?
 Which lab is processing the tests
and why id you choose that one?


More
Questions
What is the ideal result that I want to
get on this test?

When will I get the results? How will
the results be shared with me?

What is this medicine for?

Does this medication replace anything
my child is already taking?

How does my child take this
medication? i.e. on an empty stomach
or a certain time of day

How long will my child need to take
this?

What are the side effects?

Is this a new drug on the market?

What are the odds that my child may be
allergic? What symptoms should I look
for?

Is this medicine safe to take with other
medicines or supplements my child
already taking?
Consider This
RATHER THAN HAVING A DOCTOR CALL WITH
YOUR
RESULTS
CONSIDER
MAKING
AN
APPOINTMENT.
THIS GIVES YOU A CHANCE TO
CONTINUE TO BUILD A RELATIONSHIP WITH THE
DOCTOR.
IT ALSO GUARANTEES THE DOCTOR’S
COMPLETE ATTENTION AND PAYS THEM FOR THEIR
TIME.
•
Autism?!?
•
If the condition is related to autism have a copy of the
study that shows this is common with kids with autism.
I.e. Seizures. Bring a peer reviewed study showing that 30
percent of kids with autism have this and your list of
reasons you believe your child might be having seizures.
•
If the condition has nothing to do with autism make sure
you state that you are seeing the doctor for a specific
problem and that it is not related to autism.
Getting A Diagnosis
Getting A Diagnosis
Question’s to ask….
 How do you know my child has this condition? How was it diagnosed?
 What does this condition mean for my child’s overall health?
 Can it be treated? Does it have to be treated? What happens if I do not
treat it?
 Should you conduct further tests to confirm the diagnosis? If you do,
what are those tests necessary? What kinds of side effects or risks do
they involve?
 What treatment options do we have to choose from? What are the pros
and cons?
Additional Questions
 What are the benefits of seeking a second opinion?
 How can I find out more information about his condition or disease?
 Is there anything I can do to help control the condition?
 Who is the best in the world at treating this?
 Are there any clinical trails under way for this condition or disease?
 Where would you go or what would you do to treat this condition if this
was you or someone in your family?
Consider the Following:
•
Call the Emily Center and request all research and studies
on the disease or medical issue your child has been
diagnosed with.
•
Consider pursuing out of state services depending on the
diagnosis. Confirm which doctors and hospitals are leading
the way in the particular medical disorder your child is
diagnosed with.
Alternative Medicine Verses
Mainstream Medical
•
Do the research
•
If you do choose alternative medicine keep your doctor in the loop.
There are a surprising number of open minded physicians.
•
Don’t expect your mainstream physician to be able to read or
understand alternative medical labs and tests.
•
Don’t expect your mainstream physician to run DAN labs.
Remember
PRIMARY CARE PHYSICIANS AND SPECIALISTS MUST FOLLOW THE
RULES AND BEST PRACTICES.
DAN DOCTORS HAVE GREATER
FREEDOM TO EXPERIMENT. YOU MAY HAVE TO THE BASICS FIRST
BEFORE A DOCTOR WILL DO WHAT YOU THINK THEY SHOULD.
EXAMPLE: A GI DOCTOR WILL ASSUME THAT YOUR CHILD IS NOT
GAINING WEIGHT BECAUSE THEY ARE NOT EATING ENOUGH
CALORIES.
YOU MUST FIRST DEMONSTRATE TO THE DOCTOR
THAT YOUR CHILD IS CONSUMING ENOUGH CALORIES TO MAKE
THEM LOOK MORE DEEPLY. PHYSICIANS WILL ALWAYS RULE OUT
THE MOST LIKELY CAUSE FIRST.
DAN
Doctors
 Always fax your questions to the doctor in
advance of the appointment.
 Never chit chat. Stay on track as you are
paying per minute.
 Always research their advice and diagnosis
just as you would a mainstream physician.
 Have as many tests and treatments through
your primary care or specialist to save
money
Always Get A Second Opinion When….

You child needs surgery.

Your doctor can not make a diagnosis.

Your doctor is not a specialist.

The treatment is not working after a reasonable amount of
time.

Your doctor is not taking your child’s symptoms seriously
enough.
Got
EPSDT?
 If you have Medicaid all services
must be recommended by the
primary care physician.
 If you can prove that your child
improved with treatment it must be
covered regardless if the plan
covers it.
 When denied services appeal and
go to fair hearing.
 Always keep a copy of all your child’s
Remember!
records.
 Always keep a record of all
correspondence with the insurance
company and/or DDD and Long Term
Care.
 Conduct all business with DDD in
writing.
 Your Primary Care Physician is key to
winning services.