Three challenges to getting the care you need and how to overcome them

October 20, 2020 in Health Risk Management  •  By Miles Varn, MD
overcome healthcare challenges

Many people assume that if they have a good health insurance plan, that’s all they need to get access to the care they need. Unfortunately, health insurance is only one part of the care access equation. Even with a great health plan, it can still be difficult to get the care you need when you need it because of healthcare provider shortages, limited insurance provider networks, and a lack of specialists in your network who have experience treating complex and rare health problems.

Here are three of the most common challenges people face to getting the care they need and solutions that can help you overcome them.

Challenge #1: Access to primary care

A recent report from the Association of American Medical Colleges found that the shortage of primary care physicians in the U.S. is increasing. By 2032, the report projects a shortfall in primary care of between 21,400 and 55,200 physicians.

Some people chose to join a concierge or direct medical practice to gain expedited access to primary care, but that can still leave gaps in care. And even though there are a growing number of less expensive concierge practices available, costs can add up because health insurance plans don’t pay for the annual or monthly membership fee. If your concierge physician offers in-office testing and imaging, those services may not be covered by insurance or may be considered out-of-network care.

Challenge #2: Access to the right specialists

The wait time for an appointment with a specialist can be weeks or even months in some areas of the country. Even if you chose to receive your primary care from a concierge or direct medical practice, you may still have a great deal of difficulty getting an appointment with experienced specialists in cardiology, orthopedics, mental health care, and oncology.

Another thing to consider is that most concierge physicians’ referrals to specialists are limited by geography and the medical centers they are associated with, but these physicians may not have adequate experience treating the condition you’ve been diagnosed with. Your access could also be limited by your insurance carrier’s provider network or the specialist’s participation with your insurance plan. A growing number of mental health providers, for example, do not accept insurance because the reimbursement for care is low.

Challenge #3: Diagnosis with a complex or rare health problem

If you or a family member is diagnosed with a complex medical problem such as metastatic cancer, sickle cell disease, or Parkinson’s disease or a rare condition such as hemophilia or adrenoleukodystrophy, receiving care from a physician who has had both experience and success treating your condition can have a significant impact on your outcome and quality of life.

Most primary care physicians do not know where to refer patients with complex and rare conditions, so that can leave you trying to research physicians and treatments while dealing with the stress of your or your loved one’s diagnosis.

Resources to help you navigate and overcome these challenges

There are several resources that can help you get access to the care you need when you need it from the most qualified and experienced physicians. A health advisor can not only help you find an experienced primary care provider for all your family members, an advisor can also expedite access to experienced specialists.

Advisors also help lower your risk of medical errors or inappropriate care by collecting, organizing, and reviewing your medical records and arranging expert second opinions. To help you make informed decisions about your care and treatment options, advisors provide objective, evidence-based data on physicians and treatment options.

Health savings accounts and health reimbursement arrangements can be another valuable resource. You can use the money in these accounts to pay for the cost of care for out-of-network physicians and healthcare facilities, expensive prescription medications, and care provided by physicians who do not accept your insurance plan or any insurance.