Getting the Most Out of Your Health Care

You’ve chosen a health plan. Now what?

We all want to get the right health care, at the right time, for the right price. But even with a great health plan, navigating health care and health insurance can be confusing – and expensive. This toolkit can help you make smart health care decisions for yourself and your family at the doctor's office, when preparing for a hospital stay, when you need after-hours care, and in the event of a very serious illness or injury.

Please note that this information is educational only and is not a substitute for medical advice or treatment from your healthcare provider.

Tools for Better Health Care Decisions

Expand the following sections for tools to help you get the most out of your health care, whether preparing for a routine visit with your doctor or selecting a hospital for a major surgery.

At the Doctor's Office
With support from Consumer Reports Health, a campaign called Choosing Wisely can guide you through critical conversations to help you to get the most out of your health care.

Step 1: Find Trustworthy Information on What Matters to You

It’s easy to find health information on the internet, but it’s not always easy to know what information to trust. Choosing Wisely has partnered with specialty medical societies like the American College of Physicians and the American Academy of Pediatrics to develop more than 100 free guides to common medical tests, treatments and procedures. These guides can help you make informed choices about your health and your health care dollars. Topics range from heart disease tests to labor and delivery, from cancer screenings to medications for chronic pain.

Start here:

Visit Choosing Wisely to browse patient-friendly resources by test/treatment topic

For more information about tests and treatments, as well as information about drugs and supplements, hospitals and doctors and price information, visit Consumer Health Choices

Step 2: Ask the Key Questions

Your voice matters in your health care. Before getting any test, treatment or procedure, Choosing Wisely recommends asking your health care provider these five questions:

Do I really need this test or procedure?

What are the risks?

Are there simpler, safer options?

What happens if I don’t do anything?

How much does it cost?

Start here: Download a "five questions" wallet card here and bring it to your next doctor's appointment.
Preparing for a Hospital Stay
It may feel like choosing a doctor is the most important choice you can make about your health care, but choosing a hospital is just as important. And some hospitals are safer than others when it comes to things like infection rates, surgical errors and patient injuries.

Step 1: Find a Safer Hospital

Choosing a safer hospital is one of the most important health care choices you can make for yourself and your family. The national non-profit Leapfrog Group provides the Hospital Safety Grade, an easy rating system based on letter grades (A, B, C, D or F) to help you assess the safety of your nearby hospitals at a glance. Choose a hospital with a higher grade to help ensure that you and your family receive safe, high-quality care.

Start here: Visit the Hospital Safety Grade website.

Step 2: Choose the Right Hospital for the Care You Need

In addition to the overall safety score, the Leapfrog Group also provides a simple tool to help you compare nearby hospitals on specific issues that may be on your mind for an upcoming hospital stay or procedure.

Maternity care

High-risk surgeries

Infection rates

Medication safety

Inpatient care management

Start here: Use the Leapfrog Group tool to compare nearby hospitals on things that matter to you.

Step 3: Prepare for Your Visit

In addition to seeking out the safest hospital for the care you need, you can also reduce the chances of safety errors by taking simple steps as a patient or family member of a patient. Hospital Safety Score provides a set of smart tips for medication safety, keeping children safe in a hospital, preventing falls and helping hospitalized family members.

Start here: Prepare for a safer hospital experience.

Getting Care After Hours

Illness and injury can occur at any time. Knowing your options ahead of time and following-up with your regular doctor afterwards can help ensure that you and your family get the best value and outcomes when you need after-hours or urgent medical care.

Types of After-Hours Care Providers

Nurse Line

Many primary-care practices and health plans offer an after-hours nurse line you can call for guidance about minor health problems or whether you need to seek care immediately. There is typically no charge for a nurse line call.

Retail Clinic

Retail clinics can be found in grocery stores, drug stores and some big-box retailers. They are often open on weekends and evenings for walk-in service with no appointments, and some can fill prescriptions. You will likely see a nurse practitioner at a retail clinic. It’s important to tell the retail clinic about your health history, any allergies, and any medications or supplements that you take. At the end of your visit, be sure to get a record to give your doctor for your medical files.

Urgent Care Center

Urgent care centers provide a level of care that is similar to what you would receive from your regular doctor, including diagnostic services, but cost less than visiting the emergency room (both to the patient and in total health care costs). They typically operate on a walk-in basis with evening and weekend hours. It’s important to tell the urgent care center about your health history, any allergies, and any medications or supplements that you take. At the end of your visit, be sure to get a record to give your doctor for your medical files.

Emergency Room

The emergency room is designed to handle serious illness or injury, including chest pain, trouble breathing, heavy bleeding, loss of consciousness, possible poisoning or other emergency situations.

Suggested Locations to Consider for After-Hours Care (Source: BCBSM)
Type of Illness or Injury	Nurse Line or Retail Health Clinic	Urgent Care Center	Emergency Room
Bumps, cuts, scrapes	X	X
Burning with urination	X	X
Cough, sore throat	X	X
Ear or sinus pain	X	X
Eye swelling, irritation, redness or pain	X	X
Minor allergic reaction	X	X
Minor fever, cold	X	X
Rash, minor bumps	X	X
Vaccination	X	X
Animal bites		X
Stitches		X
X-ray		X
Back pain		X
Mild asthma		X
Minor headache		X
Sprain or strain		X
Nausea, vomiting, diarrhea		X
Unconscious			X
Signs of heart attack			X
Signs of stroke			X
Severe shortness of breath			X
Heavy bleeding			X
Possible broken bone			X
Poisoning			X
Sudden, severe abdominal pain			X
Head trauma			X
Suicidal feelings			X

Comparing Cost

Getting the right kind of medical care is the most important thing to consider. But if it’s not an emergency, where you go can make a difference in how much you have to pay out-of-pocket.

U-M Health Plans and After-Hours Care
Health Plan	Nurse Line (if available)	Retail Clinic	Urgent Care	Emergency Room
U-M Premier Care or GradCare	No charge	$25 copay	$25 copay	$100 copay (waived if admitted)
Community Blue PPO	No charge	$25 copay	$25 copay	$100 copay (waived if admitted)
Comprehensive Major Medical	No charge	20% of charges after deductible is met	20% of charges after deductible is met	20% of charges after deductible is met

Start here: Make a plan for where you would get urgent medical care before you need it.

Review what types of out-of-pocket costs you would pay for urgent medical care under your health plan (such as a copay or deductible).
Ask if your doctor’s office has an after-hours nurse line or evening/weekend hours.
Call your health plan's customer service center and ask about nearby retail clinics, urgent care centers and emergency rooms that accept your insurance. You can find the number on the back of your health plan ID card.
Save the contact information of the nearby clinic, urgent care center and emergency room in your phone and in a visible place in your home.
Always follow up with your regular doctor after receiving medical care from a different provider.

Additional Resources for After-Hours Care

Advance Care Planning for a Serious Illness or Injury

Whether you are 25 or 75, it’s important to write down your wishes for medical care and give a copy to your doctors and loved ones. This way, others will not have to guess what you want if you are too sick or injured to tell them yourself.

Doctors and hospitals refer to your written health care wishes as “advance directives.” In Michigan, the legal document for advance directives is called a Durable Power of Attorney for Healthcare, or DPOA-HC. A DPOA-HC names someone to make decisions for you if you are unable to do so. This person is known as your Patient Advocate.

How to Set Up an Advance Directive

Michigan Medicine has created an easy booklet and forms to walk you through the process to complete a DPOA-HC. You are welcome to use the templates with your own doctor, even if you are not a Michigan Medicine patient! One advantage of using this booklet is that it meets the requirements to be a legal document in the state of Michigan.

Here’s an overview of the steps involved.

1. Choose a Patient Advocate

Your Patient Advocate may be a friend, a family member or someone else you trust to carry out your wishes.

2. Write Down Your Health Care Wishes

This section is not legally binding in the state of Michigan, but it can serve as a helpful guide to your doctors and your Patient Advocate. This can include your preferences about pain management, life support, organ donation and anything else that is important to you.

3. Sign Your Document in Front of Two Witnesses

Your witnesses may not be your Patient Advocate, your health care provider, close family members or anyone who could benefit financially after your death. They need to watch you sign the form and sign it themselves on the same day. The purpose of having witnesses is to verify your identity and that you were mentally competent when you signed the DPOA-HC.

4. Ask Your Patient Advocate to Sign the Form

Your Patient Advocate signs to accept their responsibilities.

5. Give a Copy to Your Doctor

Provide a copy of your completed DPOA-HC to each of your doctors to include in your medical record. Give additional copies to your Patient Advocate and family members, and keep another in a safe, accessible place.

Other Resources

Visit the Michigan Medicine advance directives page for more information about advance care planning or to download the booklet and forms. You do not need to be a Michigan Medicine patient to use these resources.

Visit begintheconversation.org for additional documents and ideas about how to start the conversation about advance care planning with your loved ones.

Questions About Your Benefits?

Submit your questions to the SSC Contact Center. You can also call the SSC at 5-2000 from the Ann Arbor campus, (734) 615-2000 locally, or (866) 647-7657 toll free, Monday through Friday from 8 a.m. to 1 p.m. and 2 p.m. to 5 p.m..

Limitations

The University of Michigan in its sole discretion may modify, amend, or terminate the benefits provided with respect to any individual receiving benefits, including active employees, retirees, and their dependents. Although the university has elected to provide these benefits this year, no individual has a vested right to any of the benefits provided. Nothing in these materials gives any individual the right to continued benefits beyond the time the university modifies, amends, or terminates the benefit. Anyone seeking or accepting any of the benefits provided will be deemed to have accepted the terms of the benefits programs and the university's right to modify, amend, or terminate them. Every effort has been made to ensure the accuracy of the benefits information in this site. However, if any provision on the benefits plans is unclear or ambiguous, the Benefits Office reserves the right to interpret the plan and resolve the problem. If any inconsistency exists between this site and the written plans or contracts, the actual provisions of each benefit plan will govern.

Getting the Most Out of Your Health Care

Tools for Better Health Care Decisions

Step 1: Find Trustworthy Information on What Matters to You

Step 2: Ask the Key Questions

Step 1: Find a Safer Hospital

Step 2: Choose the Right Hospital for the Care You Need

Step 3: Prepare for Your Visit

Types of After-Hours Care Providers

Nurse Line

Retail Clinic

Urgent Care Center

Emergency Room

Comparing Cost

Additional Resources for After-Hours Care

How to Set Up an Advance Directive

1. Choose a Patient Advocate

2. Write Down Your Health Care Wishes

3. Sign Your Document in Front of Two Witnesses

4. Ask Your Patient Advocate to Sign the Form

5. Give a Copy to Your Doctor

Other Resources

Questions About Your Benefits?

Limitations

Benefits Office

Spending too much on medications? Talk to your doctor

Three easy ways to cut prescription costs

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