Insider Tips from a Nurse Practitioner & Woman Living with RA on How to Navigate the Healthcare System

Diagnosed with RA? Frustrated with the healthcare system? 


You’re not alone!


Many of my coaching clients feel frustrated with the healthcare system I did, too, when I was first diagnosed with RA. 


But I’m here to tell you there is a better way for navigating the US healthcare system.


As a nurse practitioner and a woman living with RA, I understand both sides of the healthcare system from being a healthcare provider and a patient. That’s why I have put together some insider tips to help you better navigate the US healthcare system, too. 


Let’s dive in!


Tip #1 Finding the Right Healthcare Provider


First, find a healthcare provider that’s contracted with your insurance plan. You can do this by calling your insurance and asking for a list of contracted providers. Then, ask people for referrals based on which providers are on the list. 


Tip #2 Determine Which Medications are Covered By Your Insurance 


You can take this step while you’re already on the phone with your insurance asking for a list of contracted providers. While on the phone, ask your insurance company for their prescription formulary. This is the list that tells you exactly what medications are covered and what tier. Usually there are 3-4 tiers, and this is how much they cost you out of pocket, with tier 1 typically being the cheapest. Bring this with you to your medical appointments. Check the medications prescribed against this list prior to leaving your appointment. You could also provide this list to your medical provider and pharmacy to help with the prescribing process. 


Tip #3 Medical Not Covered or Too Expensive? Here’s What to Do


What do you do if your medications still aren’t covered or are too expensive? Great question! Ask your healthcare provider’s office to do a prior authorization application for you. Sometimes, the medical office can do a simple application for you that can reduce the cost of your medication. 


You can also contact the drug manufacturer directly. There are many assistance programs for medications used to treat RA. Often, these are lengthy and time consuming applications, but they are usually good for a year. 


Last but certainly not least, ask your pharmacist or pharmacy staff for help. Sometimes they know about programs, applications, or coupons, too! This is usually true for smaller and specialty pharmacies.


Tip #4 Scheduling an Appointment with a Rheumatologist in a Timely Manner 


Let’s talk about the dreaded wait times to see rheumatologists. The average wait time for a new patient to see a rheumatologist can be anywhere from 3-6 months. Some places are as long as 9 months. Here’s my advice– Just book the first available appointment. Even if it’s 3 months away, just book it. Typically, it’s a lot easier for an office to move an appointment up to a different date than start from scratch. You can also call the office every day to ask for cancellations or new availability. Another suggestion is to politely go to the office in person and ask if there are appointments available for the same day. 


Sometimes getting something done is a matter of the method you use to approach it. 


Try to call at different times of the day. 

Try to avoid calling during traditional lunch hours. 

Try to go in person and ask to speak directly to someone about your particular concern. 


Ask who the right person is for this particular question or concern. If there is someone specific you need to speak to, ask for their direct line. Ask if this service you’re inquiring about, i.e. billing, is on-site or off-site. Often billing is not only off-site, but also out-of-state. If one way doesn’t work, try the other. 


Tip #4 Complete Paperwork in Advance 


Whenever possible, complete the rheumatologist office or medical facility registration paperwork ahead of time. Most places offer it online or will give it to you ahead of time if you stop by. Bring any and all records you have early too (more on this later.) Often there is a delay in scanning documents into the electronic health system and it’s really helpful to give plenty of time for this necessary process. 


Tip #5 Bring a Friend of Family Member with You to Your Appointments


It always helps to have an extra set of ears and eyes at your appointments. Your spouse, friend, or family member might have different questions to ask. Most importantly, always bring someone if you’re having a procedure of any kind. You really never know how you’re going to tolerate it. 


Tip #6 Take Good Notes


Take notes at your appointments. Sometimes we need time to process and recollect our thoughts before asking questions. If you want to use video or audio recording during your visit, you need to obtain permission from the office and provider first.


Tip #7 Keep a Record of Your Vaccinations 


Immunization records have become so important in the last 18 months! Keep a copy of yours handy. Be sure you’re registered with the CDC’s state vaccination tracking system for easy recall and verification. 


It’s important to keep in mind that every patient’s experience is different with healthcare providers. Just because someone had a good experience with an office or a provider, does not guarantee it will be great for you. If you have a great experience, someone else may not. There are different needs, personality fits, and different priorities between patients. 

As a nurse practitioner with 16 years of experience in the medical field working and a woman living with RA, I use my knowledge and experience to empower others to live their best life with RA. If you would like to have support navigating the healthcare system and managing your RA and reaching your disease goals, my coaching program just may be what you’re looking for. 

Click here to learn more about my coaching program and click here to schedule your free 15-minute consultation with me.


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