Helping Patients Navigate the Insurance Market Using Doctor-Patient Alliance

When it comes to health care providers, people who live in the United States have a variety of insurance plans to choose from. While it’s nice to have plentiful choices, it can quickly become overwhelming to decide which insurance plan is right for you and your family. From insurance premiums and out-of-pocket costs to deductibles and prescriptions, there are many factors to take into consideration.

Dr. Peter DeNoble is an orthopedic surgeon based in New Jersey, and he is making strides to become more transparent with his patients about their insurance options and care plans. Dr. DeNoble is President of The New Jersey Doctor-Patient Alliance (NJDPA) which aims to unite patients better and their doctors, creating greater transparency around insurance, billing, and affordable healthcare.

“We all have insurance cards in our pockets – hopefully – but each card has a little three-letter word, like PPO or EPO or POS or HMO,” says Dr. DeNoble. “Through the NJDPA, we want to help people understand what those terms mean.”

It’s true that, while many people have insurance, a lot of people are unsure what their plans cover. What access does your plan provide and how much responsibility falls back on you should you choose to see a certain doctor? The key is allowing patients the access needed to figure all of that out. Doctors should be a part of the conversation when it comes to choosing what plan is best for an individual, and their family if necessary.

“That’s the information that the insurance companies don’t want to be transparent about,” says Dr. DeNoble. “And we [doctors] haven’t been good enough about educating our patients about it either. So, we’re going to do that with the NJDPA.”

Dr. DeNoble understands that transparency is key when it comes to health care coverage. What’s the point of having coverage if you don’t know what it does and doesn’t cover?

“Transparency is never a bad thing when it comes to the consumer,” says Dr. DeNoble. “It’s always lacking when it comes to the entities and the interest groups because, if you’re going to offer me a bad plan, but it’s cheaper, I’m not going to tell you it’s a bad plan. I’m just going to tell you it’s the cheaper plan. You won’t know it’s a bad plan until you have a problem.”

Helping people to understand that their coverage may come with limitations if a doctor is needed, is essential. It can come as a surprise to many when emergencies happen- finding out you’re underinsured or have a “narrow network” can really put stress on your wallet.

“A narrow network is a situation where there aren’t a whole lot of doctors who even accept the insurance card that you have,” says Dr. DeNoble. “And knowing that you have that or not is important.”

Typically, employers offer employees a health insurance packet with some grids and some options. Perhaps you’ll discuss these options with your company’s HR person…but they don’t know your medical history. The best first step in this situation is not to make a hasty choice. Take the time to visit The New Jersey Doctor-Patient Alliance website. Here, you’ll find all the resources patients may need, from a comprehensive insurance guide to education on surprise bills, price-fixing, medicare rates, and more.

“The website provides a nice overview of what to look for, beyond what’s in the grid and what’s written for you from your employer,” says Dr. DeNoble. “You want to be able to process the information from a couple of different sources. And, if there are questions that come up, you can reach out and ask them.”

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