Welcome back to Houston How To, a podcast from the Houston Chronicle.
Humans have an innate drive to improve themselves, and we’re always striving to live better. This podcast and our twice-weekly column wants to simplify that for you.
I’m Gwendolyn Wu, a reporter on the business desk here at the Houston Chronicle. I write about what you need to know about living in Houston.
I was born and raised in a suburb of Los Angeles, and on the afternoons I wasn’t at Chinese school as a kid, I was running around the tiny dentist’s office where my mom worked as a receptionist. Actually, running around might be kind of an exaggeration because it was so small, only four people worked there. Well, either way, in my teens, my mom was the only one who was working, and I bounced around on the state health insurance system as a result. That’s how I started learning about what PPOs and HMOs are and scrambled to find new doctors every single time my provider stopped taking the insurance that I had. So you could say I’m pretty familiar with medical plans at this point.
In case you haven’t figured out by now, we’re talking about health care today on Houston How To and how you can navigate health insurance to pick a doctor that’s right for you. Moving to a new city or starting a new job can mean changing health insurance providers and primary care physicians. But for many Millennials and Gen Z-ers who are just starting full time jobs with actual health insurance, — I know right. What a concept –i It’s super confusing to figure out which doctor is right for you.
Let’s start with health insurance. Insurance should cover most of the cost of your medical bills as long as you remain in network, meaning that you have to choose a doctor from a pre-approved list of medical providers. There’s two types of plans for health care, usually. Health maintenance organizations, or HMOs, are larger plans that will pay for health care costs, but they won’t go all out for anything that’s incurred outside of their network.
Typically, HMOs are cheaper because they only work with a select group of doctors, optometrists, dentists, you name it, they probably have at least one of those people on their roster. Preferred provider organizations on the other hand, or PPOs, some pretty much like their name suggests: you have the flexibility to see doctors who usually don’t work with your insurance. If you go out of network, meaning you seek medical care from someone who doesn’t work with your insurance company, you can usually take your bill to your health insurance company to see if they’ll pay for part of the price. When you have health insurance, your provider will have a list of pre- approved prices or percentages of how much they’ll pay for your bill and what you have to do is pay the co-pay. If you’re in an emergency, though, health insurance, no matter whether you’re with a PPO or HMO, will pay for your ER costs if they deem it medically necessary.
That gets kind of tricky to define, the same way it’s tricky to define pricing list at local hospitals, as we’ve previously reported here at The Houston Chronicle. Once you’ve squared away the knowledge of how much it cost to have a doctor, though, you have to well, actually, find a doctor. And there’s a lot of things to consider when it comes to picking the right physician for you.
A lot of big providers will have a directory showing what types of medical practitioners they work with, including relevant information like their gender) if you prefer seeing a male doctor or a female doctor_ where they’re located, if for some reason in Houston they’re not in that giant Texas Medical Center complex, and any specialties like pediatrics or gynecology. There are some websites out there that will also help you figure out which physician is right for you. ZocDoc is a great place to see patient reviews, and there’s always the worthwhile backup of Google reviews and Yelp just in case you want to find others.
I like using all three of them, because even in the one star doom and gloom reviews, you’re usually able to find a good nugget, such as somebody who’s telling you what the trend is among reviewers about if they have outdated equipment. Or maybe they’re talking about very simply how the business responds to consumer complaints.
And if that doesn’t up working out for you after you pick a doctor, remember, a doctor doesn’t have to be permanent. If they’re uncomfortable at your doctor’s office or feel like you didn’t get high quality care, you can switch your primary care provider. However. keep in mind though that you want to do that sparingly. A doctor gives better recommendations and medical aid if your medical history is already on file with their office. Plus some insurance providers will have limits on how often you can switch your doctor.
There’s a couple other things to consider when picking a primary care physician. If you have a chronic illness or you’re prone to some kind of sickness, an internist, a doctor who specializes in internal medicine might be a good choice.
Or if you’re somebody with young children, you could go to a family practitioner instead. Don’t be afraid to call potential medical providers not only to double check if the office takes your insurance, but also to gauge the vibe of the other staff who work there. Is the person who picks up your call friendly? Do they take care to ask what kind of services you need?
And maybe in this case, you’ve already had insurance and you’ve already had a doctor lined up for years. The problem actually is motivating yourself to go to the doctor.
I’ve heard three different variations of this defense for my friends in recent years. One being you’re healthy, you don’t need to check up. Or you have fear that a doctor is going to be upset if you haven’t been there in ages. Or maybe you have anxiety about calling and booking an appointment and not having time off to go.
Either way, a lot of these problems boil down to one essential answer. There’s no shame in going to see a doctor for a checkup. You can’t say you’re healthy if you don’t get a checkup from a person who, I don’t know, went to medical school and can confirm for you exactly what your health status is like.
For one, I’m a fairly healthy 22 year old woman but I didn’t think going to the doctor’s last year would result in me leaving with instructions on how to care for the acne flare up on my face. That was something I didn’t count on, but also something I wouldn’t have paid attention to if my doctor hadn’t talked to me about it.
So when it comes to being afraid to go, I’m right there with you. Despite being a person who literally calls people and bugs them with questions for a living, I still sometimes have to walk a lap around my house before I can convince myself to type in a doctor’s phone number.
As a solution, some health insurance apps also let you book an appointment without having to ever call and talk to a human being on the phone. Other apps for health insurance also allow you to search for doctors who may be open later than the usual 9 to 5 or settle your claims, which is what you do when you go out of network and need to provide the bill to your insurance.
They should also all feature some sort of information from your insurer to make sure that you have information you need at the doctor’s office if asked. Hopefully, these chips will answer your worries about navigating health insurance.
I can’t be the only one with questions on how to life hack my way through living in Houston. So, Houston, what are you curious about? If you have tips or tricks on improving our lives, I’m also all ears.
Email me at Gwendolyn.Wu@chron.com and if I use your idea, I might give you a shout out. For more tips, be sure to check out the twice-weekly Houston How To column on the Houston Chronicle’s website and in print. Follow me on Facebook at Gwendolyn Wu or on Twitter @gwendolynawu. Thanks for listening to Houston How To. See you next time.
Thanks to All the Kimonos for our music. My editor’s Dwight Silverman and Scott Kingsley is The Chronicle’s podcast editor. This episode was produced and edited by Ferril Gibbs.