Tag Archives: care

Types of Providers

Types of Providers

If you have complicated health issues or your doctor has called another doctor an industry term you’ve never heard before, you may be left wondering what all these health care names really mean. We can help you make sense of the different types of providers.

Your Doctors

Primary Care Provider (PCP)

A primary care provider, or PCP, is your main doctor. It’s who you visit for routine checkups, preventive care, and general health problems. Each person in your family can have a PCP, or you can all see the same one.

If you’re on an HMO or POS plan, you have to choose an in-network PCP who will oversee your care and refer you to specialists. If you’re on a PPO plan, you don’t have to choose a PCP to get referrals, but you can to get personalized care and savings.

And if you’re a woman, you can set a doctor as your PCP or choose another in-network doctor, like an OB-GYN, to oversee free preventive care, your yearly well-woman visit, or a pregnancy.

Setting and changing your PCP is easy. Just log in to Your Health Alliance to update your PCP.

Specialist

A specialist is a doctor who provides health care services for a specific disease or part of the body, like dermatologists, who focus on skin care.

Usually, you’ll be referred to a specialist when your personal doctor wants you to check on specific issues or problems. You’ll also be sent to a specialist when you’re diagnosed with something serious, like a heart condition or cancer, or if you find out you’re pregnant. 

Surgeon 

A surgeon is a doctor who is qualified to perform surgery, and they have their own specialties. If you have a heart attack and need surgery, your surgeon will be an expert in heart surgery.

If you’re sent to the ER because of an emergency or diagnosed with a condition or disease, you might be sent into surgery. But if you need a minor procedure, like having your wisdom teeth out, you’re seeing a surgeon too. 

Hospitalist

A hospitalist is a dedicated, in-patient doctor who works only in a hospital or network of hospitals. If you’re taken to the hospital in an emergency or accident, you might be treated by a hospitalist.

Help with Your Care

Care Coordinator

Care coordinators help you figure out your health care in lots of ways, especially after a hospital stay, diagnosis, or if you have a chronic or complex condition.

They can help provide you with resources, educational materials, and self-care techniques, help you understand your doctor’s instructions, connect you to resources in your community, and help you plan for the future.

Health Coach

Health coaches can help you or your family plan for better health. Our health coaches can help you get the best care possible from your healthcare team and get the most from your coverage.

They’ll partner with you to help in areas like nutrition, weight and stress management, and preventive screenings and immunizations.

Nurse Navigators

You might get help handling your care from a nurse navigator when you’re discharged from the hospital if you get a serious diagnosis. For example, a cardiac nurse navigator will help patients with a primary diagnosis of heart failure or myocardial infarction.

They will usually start the process by visiting you before you leave the hospital, then they’ll stay in-touch to walk you through the first 30 days after discharge. 

Nurse navigators can help you organize your appointments, connect you to education on your diagnosis, medications, exercise, diet, therapies, and when to call the doctor. And they might host support groups that can help people like you.

Other Kinds of Care

Home Health Care

Home health care is medical care, treatment, or skilled care you can get in your home. You doctor might recommend this in situations where care in your own home will be easier for your case and condition.

Skilled Nursing Facility

You doctor might order medical care that must be given or supervised by a licensed health care professional in a skilled nursing facility. This type of care could include:

  • X-rays and other radiology services
  • Physical, occupational, and speech therapy
  • Storage and administration of blood
  • Use of appliances, like wheelchairs
  • Meals, including special diets
  • A semiprivate room or private room if medically necessary

Hospice Care

Hospice care is special care for people who are terminally ill, including medical and physical care and help with social, emotional, and spiritual needs. It also provides support for family and caregivers.

Other Help

Pharmacist

Pharmacists are healthcare professionals who practice pharmacy, which focuses on safe and effective medication use. You might not think about your pharmacist’s skillset when you pick up your drugs at the pharmacy, but they’re trained to know how drugs work.

They know which drugs can interact to protect you from dangerous drug combinations, they can explain the side effects of your drug to you, and they make sure you’re getting the right dosage of your drugs on the right schedule.

Social Worker

Social workers are there to help you with social problems that can affect your quality of life and health care. They can help you and connect you to resources for domestic violence, sexual assault, abuse and neglect, housing and food insecurity, home-delivered meals, substance abuse, mental health issues, advance directives, and more.

Other Providers

Medical Director

A medical director is a leader who recruits and manages doctors, nurses, and other personnel. They also examine and coordinate processes within their organizations to improve and guarantee the medical quality of the facility. 

 

If you need to find covered providers, use our Find a Doctor or Hospital tool to search for covered doctors, hospitals, and more.

National Financial Wellness Month

National Financial Wellness Month

It’s National Financial Wellness Month, and we have tips about taking care of your finances, especially as they relate to health insurance.

Using Your FSA

If your health insurance features a flexible spending account (FSA), you could save on all kinds of health services and products.

Your FSA and the New Year

 

Health savings accounts (HSAs) are becoming more common, and if your plan has one, it could help you with your medical expenses and offset high deductibles. 

Saving with an HSA

 

You might not realize how much money you’re losing going to the emergency room when you should be going to urgent care. Know where to go and save.

Skipping the ER

 

You know you pay a premium for your health insurance, but do you understand all of your out-of-pocket costs, like deductibles, copays, and coinsurance? Make sense of what you pay.

Paying Out-of-Pocket Costs

 

Do you know what happens after you get care? Make sense of the claims process, how your doctor gets paid, and what you’ll owe.

Paying Healthcare Costs

 

Making financial plans for your future can help you be ready for retirement, Medicare, and medical emergencies. Be prepared.

Making Financial Plans

 

Financial wellness can impact other parts of your health too. These tips can help you track your spending, set goals, and more.

Safe Travel Each Step of the Way

Safe Travel

Summer travel season is upon us, and preparing for safe travel is important, especially if you have an illness.

First, learn about your destination to check for any local health notices or immunizations you might need first.

Safety Wherever You Go

 

Think about your health before you book. From illness and surgery recovery to pregnancy, check if you’re safe to fly.

Fly Smart

 

See a doctor before you take off to make sure you’re up-to-date on key shots or healthy enough for planned activities.

Vaccines for Travel

 

Pack carefully to protect yourself, especially if you need medicines or care while you’re traveling.

Pack for Your Health

 

Be prepared for the signs and what to do if you know you’re at higher risk of health issues while traveling.

Healthy and Prepared on Vacation

 

Make sure your family or friends (and government entities depending on where you’re traveling) know your travel plan.

Share Your Travel Plan

 

Know you’re covered with a copayment or coinsurance for ER and urgent care if you get sick while traveling.

And check out Assist America, which helps connect you to services when you get sick while traveling.

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Children’s Mental Health Awareness Week

Children’s Mental Health Awareness Week

Last week was Children’s Mental Health Awareness Week. Olympians Michael Phelps and Allison Schmitt helped raise awareness about children’s mental health.

Happy, Healthy Children

 

Your children may seem healthy, but you never know what’s happening in their heads.

 

Community members can help young adults by knowing the signs.

 

You can help a young adult with mental health issues by being a source of support.

 

Communicating with your doctor and family about your mental health is an important lesson to teach your kids. Teach them to share their feelings.

Children and young adults with mental health problems need real care and support.

 

Social health, which could include friendships and bullying, is an important part of your kids’ mental health. Learn more and talk to them.

Their Emotional and Social Support System

In Case of Medical Emergency

Long View: What Is a Medical Emergency?

According to Medicare.gov, a medical emergency is a situation where “[Y]ou believe you have an injury or illness that requires immediate medical attention to prevent a disability or death.”

It seems pretty straightforward, so why are there so many questions around the decision to get treatment at your local emergency room?

An emergency room (ER) provides some of the most sophisticated diagnostic options in a hospital and the most immediate care to patients in crisis.

The list of possible emergencies is endless, so it’s important for you to recognize how serious your injury or illness is and to know the best way to get treatment for it.

Many of us have heard about folks with medical emergencies driving themselves to get treatment or catching a ride with a family member. Please don’t. Driving yourself puts you and others in jeopardy and delays the start of your treatment. Dialing 911 brings you the treatment quickly and gets you to an emergency room faster than a white-knuckle trip across town, dodging traffic lights.

Dr. Frank Friedman, one of our medical directors who specializes in emergency care, said, “A true emergency is one that can’t wait. It is something causing such severe pain or such a risk to life or limb, for oneself or a loved one, that it can’t wait hours, or a day or two, to be seen by one’s own doctor or healthcare provider.”

If it’s not an emergency but you need medical care to keep an illness or injury from getting worse, call your doctor. If your doctor can’t see you right away or the office is closed, urgent care (or convenient care) can help you get treatment quickly.

Over the years, I have heard some interesting and alarming questions from our members. This FAQ can help answer those questions.

Q. I just got one of your policies, and I’m having severe chest pain. Will you cover me for an ER visit?

A. This is one of the most unsettling questions we receive. If you’re experiencing severe chest pain, don’t call your plan, call 911. It’s as simple as that.

Q. Do I have to pay a copay when I get there?

A. No, they should be able to bill you, so there’s no reason to wave your credit card around as they wheel you through the front door. In fact, under federal law, an ER has to evaluate and stabilize you in an emergency medical situation, without regard for your ability to pay.

Q. What if I have special conditions they need to know about?

A. Keep a list of your medications with you. MedicAlert’s medical IDs or the Yellow Dot program can also help you share this information. And many smart phones have features that let you add emergency contacts and medical information. Plan ahead.

Q. What are some examples of when I should go to the ER and when I should go to my doctor or urgent care?

A. Visit the ER for emergencies like chest pain, broken bones, poisoning, shortness of breath, fainting, and seizures. For things like a constant fever, strep throat, sprains, the cold or flu, earaches, or minor infections like pink eye, call your doctor or visit urgent care.

Will you recognize a medical emergency? Probably yes, so trust your judgment, act quickly, and please be careful out there.

Patrick Harness is a community liaison with a long history of experience in health insurance. If you ask him to pick a color, he always chooses orange, and he is known for his inability to parallel park.

Your Personal Health Coach

Vantage Point: A Helping Health Hand

Not every coach is as well known as Pete Carrol of the Seattle Seahawks, but Susan DeLong, our nurse case manager and health coach in our Wenatchee office, is key to our team.

She’s smart, caring, a good listener, and a compassionate advocate. You will probably never see her on TV, but in our members’ eyes, her work is just as important and meaningful as any superstar’s.

Managing a health condition can be hard, and a health coach is someone with extensive experience who can be a consistent source of support. There’s so much information that it can be hard to know what’s key. One of the benefits of a Medicare Advantage plan like ours is the free education and support a health coach can provide.

At Health Alliance, a health coach like Susan can give our members:

  • Answers to questions about their conditions
  • Tools and lifestyle skills to minimize the risk of problems
  • Information about self-care skills
  • Free educational materials and resources about managing conditions
  • Support on the phone at their convenience
  • Help keeping them, their provider, and their caregivers connected
  • Help making the most of their healthcare benefits

Health coaches do not replace medical care from a doctor, but instead work with their primary care physician as part of a team to make sure their management plan is working.

Compassionate nurses like Susan also help identify warning signs for possible health problems, and they make sure members have a plan, day or night, to handle those issues if they become serious.

Susan also works hard to troubleshoot these issues before they become serious health problems. For example, she helps members understand the importance of refilling prescriptions and outlines what they should do if their drugs run out too soon.

Susan even partners with community resource agencies, like Meals on Wheels and the Confluence Health Patient Service Department, to help our members overcome barriers to their care. She knows when a member has a hospital stay or ER visit, and she tracks follow-up appointments and makes sure any meds they’re sent home with will work well with their current prescriptions.

But just like famous coaches, a big part of the job is to motivate. Susan empowers our members to take an active part in their health by setting attainable goals, and we value the important role she plays in our team and in lending a helping hand to our members.

Shannon Sims is a Medicare community liaison for Health Alliance, serving Chelan, Douglas, Grant and Okanogan counties in Washington. She has four sons and two grandsons. During her time off, she performs as part of a rodeo drill team on her horse, Skeeter.      

Diabetes Resources and Treatment

National Diabetes Month

November is National Diabetes Month, and now’s the time to raise awareness and protect yourself.

86 million Americans are at risk of developing diabetes. Learn how you can protect yourself starting at home.

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This month is also Diabetic Eye Disease Month. ‪‎Diabetes‬ is the #1 cause of new blindness in adults. Learn more.

Eye Exams and Diabetes

 

Understanding your diabetes can be kind of like football, from U.S. News and World Report.

Visit our diabetes section to learn more about taking care of you or your family’s disease.

Diabetes is more common and more serious than many Americans realize. Protect yourself now.

Diabetes by the Numbers

 

You can help stop type 2 diabetes in its tracks with smart shopping and eating. Find resources from the American Diabetes Association to get started.

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Exercise is an important part of taking care of and preventing diabetes. Programs like this can help, from NPR.

Interested in learning more about diabetes from our different partners’ health experts? Check out our events page for presentations and videos.

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