Your Role as a Healthcare Consumer

Today we recognize that the quality of healthcare improves and outcomes are better when you actively participate in your care. That means asking questions and taking an active role in decisions, such as what health plan to choose, adopting a healthy diet and exercise regime, and managing the treatment you receive when medical care is required.

However, when you or a family member are undergoing medical procedures, you may not know the questions to ask the doctor. Or, you may need some assistance in selecting a physician. Following is a list of suggested questions to help you select a doctor and questions to ask during treatment. They’ll help you gain a better understanding of the situation and the treatment that is being recommended, so you can partner with your doctor in making decisions that impact your health.

What You Should Ask

When Selecting a Physician

It’s important that you select a doctor who has the knowledge and clinical experience that you need, is certified, and makes you feel comfortable. Some questions to consider when selecting a physician are:

  • Does the doctor accept Medicare and, especially, Medicare assignment (the doctor accepts the Medicare-approved amount as payment in full on all Medicare claims)?
  • Do you prefer a male or female doctor?
  • How many doctors are in the practice? Are you comfortable seeing other doctors if your primary doctor is not available?
  • At which local hospital does the doctor have admitting privileges? Are you comfortable being treated at that hospital?
  • Is the doctor’s office easy for you to access?
  • How long do you need to wait for an appointment?
  • Does the doctor take the time to listen to your concerns and explain your condition and treatment clearly?
  • Is it easy to ask follow-up questions after an appointment? Does the doctor or staff respond quickly to questions?
  • Does the doctor offer email access for non-emergency questions?
  • Is the staff friendly and interested in you?

Don’t be afraid to ask for an “interview” appointment. It’s important that you are comfortable and feel that the doctor will work with you, address your concerns and provide you with the best possible healthcare. You may need to pay for a cost share or fee for this appointment, but it will provide you with valuable information when selecting a physician.

When a Test Is Suggested

  • What is the purpose of this test?
  • How accurate is it? Is it definitive or will additional tests be needed?
  • What will it cost? Is there a less expensive alternative?
  • If the test detects a problem, what happens next?
  • If the test doesn’t detect a problem, what happens next?

When a Procedure or Treatment Is Suggested

  • Why are you recommending this procedure/treatment?
  • What is it, and how is it done? How likely is it to solve the problem?
  • What will it cost? Are there effective, less invasive alternatives to try first?
  • Are there risks or side effects to the treatment? Pain or discomfort? For how long?
  • What is likely to happen if the procedure isn’t done?

If Surgery Is Needed

  • What is the hospital’s experience and outcomes with the procedure?
  • Are there other facilities that specialize in this procedure?
  • What are the costs and how much will I be responsible for?
  • Are all the doctors on the treatment team in my network? If not, can a network doctor join the team? If an out-of-network doctor remains on the team, will he negotiate on the fee?

When Your Prescription Is Renewed

  • Is there an equally effective generic, or lower-priced alternative of my prescription drug?
  • Can my prescription be sent directly to Express Scripts’ home delivery program for a three-month supply?

Do You Still Have Questions?

One important benefit that all healthcare plans provided by the Medical Trust offer is Health Advocate. This resource can help you:

  • Understand the questions to ask about your treatment
  • Find a doctor or specialist
  • Get a second opinion
  • Resolve benefit claims and correct billing mistakes
  • Research rehabilitation and after-treatment care options

Health Advocate is there to help you. Staffed by medical professionals, Health Advocate will help to answer your questions and understand your situation.

For details:

  • Download the Health Advocate brochure.
  • Sign in to Health Advocate (password: episcopal).
  • Call (866) 695-8622, 24 hours a day, 7 days a week. Normal business hours are Monday through Friday, 8:00AM to 9:00PM ET. Staff is available for assistance after hours and during weekends for issues that need to be addressed during non-business hours.

Health benefits are offered through plans maintained by Church Pension Group Services Corporation (doing business as The Episcopal Church Medical Trust), 19 East 34th Street, New York, NY 10016.

The Episcopal Church Medical Trust Disclaimer

Unless otherwise noted, websites referenced herein that are outside the www.cpg.org domain are not associated with The Church Pension Fund and its affiliates (collectively, the Church Pension Group) and the Church Pension Group is not responsible for the content of any such websites.