Nimeet K 00:11
Hello, Welcome to the Adventist HealthCare & You podcast. We are back with our next episode. Today i'm joined by our special guest co-host Tina Sheesley, Tina why don't you introduce to our listeners.

Tina S 00:22
Hey there, Nimeet. It's great to be here, filling in for Shanna. I am the Director of Public Relations and Marketing for Adventist HealthCare Shady Grove Medical Center, I'm celebrating 10 years with our organization. And I love connecting the community, to our great caregivers and other health-care resources, with topics like we're going to discuss today.

Nimeet K 00:42
Absolutely. So we have an interesting topic today. We will be discussing health care options for when you must start making decisions on your own. We have our two experts today, one being Dr. Ogechi Anyaoku, who is our internal medicine physician with Adventist Medical Group at Fort Washington. And then we have Carlos Vargas, who is vice president of human resources and technology at Adventist Healthcare, and the chief human resource officer at Howard University Hospital. So welcome to our experts.

Carlos Vargas 01:11
Thank you. Thanks for me.

Ogechi Anyaoku, MD 01:12
Thank you.

Nimeet K 01:13
Absolutely. So Carlos, we'll start with you. When do you need to know when starting out choosing an insurance plan through your employer or if once in offered through them?

Carlos Vargas 01:22
So it's a question, what is the best choice for you?

Carlos Vargas 01:25
Well, hopefully, if you have an employer, they have choice, a plan to have the best efficient plan as possible. So that's your first choice. If you don't have it through an employer, you do have through the Maryland Exchange, a whole host of options that are available too, if you have specific types of issues, whether it's mental health other some chronic issues, you can actually purchase a plan that's tailored to your needs.

Nimeet K 01:25
Yeah

Tina S 01:48
And Carlos, the Adventist HealthCare benefits team is so great in walking our employees through this. And so whether our listeners are part of our family here, or listening to this and wondering, how do I navigate this through my own employer, if I don't have insurance, you know, what kinds of things do you hear people coming to ask about when they've reached this point, whether their parents, you know, coming to say I have a child approaching a young adult, I should say approaching age 26? Or whether they're the young adult themselves?

Carlos Vargas 02:18
Yeah, the question is, Do I really need it? Do I need insurance?

Nimeet K 02:22
Yeah

Carlos Vargas 02:22
Parents usually do, I always encourage them the state on their parent's insurance, because usually a family plan is more efficient than going out on their own, because then you have to fill your own deductible. So it was a change in the law back several years ago. And it was a great, great opportunity, because a lot of times people were turning 21 And then losing coverage. And then maybe they don't, they're starting at entry level roles that don't offer a plan.

Carlos Vargas 02:50
So that age 26 provision that allowed us to continue on the parental plans. And then the offering of the exchange gave a lot of options for folks. So you can keep the price down as well. So that's the number one question should I get? Should I even waste my time getting? Absolutely yes. And if you're looking, if you've done the math, the exchange, the Maryland Exchange offers a lot of choice and options there even more than maybe a single employer. So don't be afraid of the exchange. And using that it's probably the second piece of it, you know, even at a minimum if they offered catastrophic coverage, but at a minimum achieved catastrophic coverage, and the prices are pretty efficient. Other than that, I think those are the two primary primary questions.

Nimeet K 03:38
Great! Thanks for sharing the Carlos. So you know, I've seen many organizations offer so many benefits, including Adventist HealthCare, you know, we offer a lot of benefits. At times I see people not utilizing all of them. So what are some of the benefits that you see people not utilizing or some of the benefits that you should look out for they'll be highly beneficial?

Carlos Vargas 03:58
The mental health benefits are extraordinary nutrition services, rotation services, there's a whole host of things even through engineered care, navigation benefits, helping you navigate this quagmire of health care

Tina S 04:12
is so important for young people to you know, as you're learning how to navigate your own health care. I think once until you're in it, you don't really realize how challenging that can be. So having someone as part of your plan to walk you through things is extraordinary. So

Nimeet K 04:28
if I'm if I'm a, you know, young adult, like, maybe 2122 I'm trying to look for health care options, but I'm not a new employee. It's not open season. How do I look find health care or benefits like that?

Carlos Vargas 04:41
Well, if you're not tied to an employer, the health exchanges is your primary. And most states have some type of exchange that they're offering. And so that's where I would go is gone on their website.

Nimeet K 04:55
Yeah and I think you mentioned it earlier, but it helps like navigate our already complex health care system, and just shows options of what's availabe. Many times people don't even know what's available, but just, you know, simple call call to your benefits team or your HR team could help.

Carlos Vargas 05:09
Don't be afraid to ask we have a lot of resources that we can connect you with a lot of professionals and experts, you can't be ashamed that you don't know, because it's so complex that we've got all these types of experts that help us. And I've been in the business for 35 years, and it's still complex to me.

Tina S 05:25
Right, so let's say we've taken your advice, we've stayed on our parents health plan, we're 25, pushing 26, what are the things we need to know to make that transition? And can you clarify is it you know, a switch we need to make on our birthday, when we turn 26, is it a switch by the end of the year? Walk us through that actual change, for those who are reaching that milestone.

Tina S 05:49
In general, you have 31 days, you have a 31 day window from the time from your birthday, to apply to the exchange. Or obviously, if you're employed, that serves as a qualifying event, you don't have to wait till their open enrollment. It may vary by certain employers, but a 31 day rule is good to keep in mind. So do something within 31 days of your birthday. Otherwise, you may go a period without coverage. And you'll have to wait until an open enrollment period at your employer or the exchange to obtain coverage.

Nimeet K 06:27
And typically, your HR team or benefits team would work with you to help you navigate the system and say, you know what, this is what works in our company. And this is what you need to do. So like typically, whoever it is going to, you know, the HR team, they could help navigate this part for you. It's not that, you know, as soon as they turn 26, they're done, like, you know, that's going to communicate with them.

Carlos Vargas 06:47
Yep, we'll try to create a gap, close any gaps that we might see well said, Nimeet.

Nimeet K 06:52
Alright, so I'm fully insured. I'm a young adult trying to go for, you know, to visit a doctor. Many times, I don't, because I'm a young adult. So you know, that's typically what we see. So Dr.Anyaoku, is that true? Is that what you see in your practice as well that you don't see younger adults coming to find a PCP or visit the doctor's office?

Ogechi Anyaoku, MD 07:16
So, I have heard that misconception, quite a lot that young people don't need to see providers. Although I have been seeing a little bit of a different trend recently, I do see a lot of young patients, now. I would say that everybody across the lifespan needs a primary care provider. So just as children see their pediatrician, at least yearly, or sometimes even more, and adults and older adults also need to see their primary care providers with regularity at least once a year. So when you're seeing your provider, you're able to develop healthy living habits, you're able to develop a plan that will prevent disease onset or at least delay the onset of some diseases, and just have at least some sort of a baseline of what your health status is.

Nimeet K 07:59
So is that what you're expecting your first visit during when you're turning? 26? You know, is that the part of the conversation you're having the first time around with them? Or what are some of the screenings, that we're doing the first time around?

Ogechi Anyaoku, MD 08:11
Yeah, so it depends on age, and definitely you're trying to just get a background history of the patient. And you want to know what their past medical history is, you want to know what their family history is, so that way we can determine what your risks are for developing certain diseases. So for example, common diseases that we treat in primary care are high blood pressure, diabetes, high cholesterol, we want to get that information, we want to know what your a one c is. So we know whether or not you have diabetes, or prediabetes or what your risk is for developing diabetes.

Ogechi Anyaoku, MD 08:44
Same with hypertension, your blood pressure or your cholesterol numbers. That gives us an indication of whether or not you're at risk of developing cardiovascular disease. And definitely around the age of 26, or in your 20s, you want to start thinking about talking to your provider about what immunizations you might need. And again, what risks you might have, depending on what your personal health history is, or what your family history is, in terms of different cancers that may develop in your family.

Nimeet K 09:12
Yeah, I think that having a conversation about past medical history or family history is so important, right? Because, I can speak from personally, I do have extensive cardiac history from both my parents, and I was able to tailor my health through the channel that is necessary, based on the risks that I may have or may develop in the future. So I think just having those transparent conversation and building that relationship is highly valuable and important. Same time.

Ogechi Anyaoku, MD 09:38
Absolutely.

Tina S 09:39
I'm sure it's pieces to a puzzle, that without them, it makes your job a lot harder, right?

Ogechi Anyaoku, MD 09:44
Yeah, having as much information as possible definitely makes navigating your health journey much easier.

Tina S 09:51
And, so let's say I'm moving out of my teenage years into my 20s, out of the pediatric world, trying to find a primary care provider of my own, what are some things that a young person should look for when selecting their own physician?

Ogechi Anyaoku, MD 10:04
Yeah, so that's a good question. And I think it's very individual, I think baseline, you want to make sure that you find a provider who will listen, someone who will be just as much of an advocate for your health care as you are. You want to have somebody who's respectful, who respects you, what your needs and goals are. And you just want to find somebody who whose style of treatment is in line with what your values and what your goals are. One of the ways that you can try to find a provider because it can be very difficult, there's so much information out there, would be to ask family members, ask cousins, friends, parents who they see, because oftentimes, you will like who your family members or your friends see as well. You can also do a search online to find providers in your area, you can contact your insurance company, and they can also provide you with providers in your area. So I think those are some of the ways that you can find a provider.

Tina S 11:02
And that's important. An important tie back to what we've been talking about is making sure that your insurance, whatever insurance plan you have, or select is going to cover their provider

Nimeet K 11:12
I've also asked our colleagues before because they have the same insurance plan as you and you know, they get good feedback from some of the colleagues and you know, I love this doctor, and they're great. And their covered by our insurance, so I think you know, just asking around or word of mouth kind of goes long ways to.

Ogechi Anyaoku, MD 11:27
Absolutely.

Tina S 11:27
And of course it never hurts to go to AdventistHealthCare.com, when you're looking for a doctor either, because we have so many great ones like you.

Ogechi Anyaoku, MD 11:34
Thank you. Yes, we have several providers across all the specialties.

Nimeet K 11:37
So do I, when i'm looking for a doctor, do I just go for primary care physician? Do I need to see a specialist right away? How does that work?

Ogechi Anyaoku, MD 11:45
So initially, you should just see your primary care provider, then they will be able to do an evaluation of whatever your conditions or concerns may be. And if they feel like they can handle that, then they can manage that. But if they feel like this is something that needs to go outside, and they can give you a referral to a specialist. One of the common concerns and issues that I see is young women, they tend to maybe only see an OB-GYN, not realizing that their primary care provider can provide a lot of the basic management that an OB-GYN can. And of course, you know, if there's something that the PCP cannot handle, then they can refer out to the OB-GYN. And definitely if a woman is trying to conceive or is pregnant, then for sure they definitely want to see their OB-GYN, but otherwise, for most basic things we can manage those as well.

Nimeet K 12:35
I think the good thing about the PCP is they know all kinds of specialties and who to refer to and where to refer to and when kind of thing. So it's like a one stop shop, you go there, but you know what, you need this kind of specialist and you kind of get navigated towards there.

Ogechi Anyaoku, MD 12:48
Right, absolutely.

Tina S 12:49
When are the times where you might need to change your provider? What are some things that a patient should look out for, and say you know, maybe this isn't the right fit?

Ogechi Anyaoku, MD 12:57
Yeah, that's a good question. Very important. Because, as I said before, you want to make sure that you feel like your provider is listening to you, that they have your best interests at heart. So if you do feel like, you know, you've been talking about an issue for a long time, and it doesn't feel like your providers really taking you seriously, or they're not really looking into it further, or you're just feeling uncomfortable with your current care. Absolutely, you should search elsewhere to find somebody that's a better fit for you.

Tina S 13:26
And I think sometimes people don't feel empowered to do that, because they might have an established relationship or because a friend recommended them or a family member is going to see them, there's a little bit of awkwardness there. It's so important or important to feel empowered in the health care decisions that you make.

Ogechi Anyaoku, MD 13:41
Because at the end of the day, it is your health, and you're your biggest advocate, no matter what that provider has done for you, you still have to be your biggest advocate.

Nimeet K 13:52
So if my insurance changed recently, or if there's a new newer medication added on to my diagnosis, or whatever i've been getting treated for, how do I ensure that it's covered by insurance? Or what if it's not covered by insurance? How does that work?

Ogechi Anyaoku, MD 14:06
So you can talk to your provider about any medications that you're taking, they may be able to suggest different medications that would do similar work similarly to what you were already on. But if it's something that you just don't want to go down that route, and you want to make sure that you're staying on that medication, then your provider can submit paperwork to your insurance company, just telling them the importance and then medical necessity of you being on that particular medication.

Nimeet K 14:32
That's amazing. I mean, I didn't realize you could have a conversation with your provider and you know, sending that letter to the insurance company. That's something I learned for sure.

Tina S 14:40
You know, we're talking about insurance and everyone's mindful of health care costs. What are some things that are appropriate for our listeners, you know, when they're having these conditions to call the primary care provider versus going to see an emergency room or having it dealt with at urgent care? What are how can we help people navigate that?

Ogechi Anyaoku, MD 15:05
I love that question. That is a beautiful question. Because we do see a lot of that. And then it does basically come out to high cost care, right. So I would say most things, just give your provider a call first, unless it is a very severe symptom that you're having. So symptoms of like a stroke. So facial drooping, loss of control of your muscle movements, or you're completely passing out, those types of things should go to the emergency room, an emergency. But if it's that your blood pressure is a little bit higher than it normally is, or if you have a headache, or you just have you know, a little bit of a stomach upset, you've been vomiting, things like that. Those are things that you definitely want to run by your provider first. And then they can basically tell you no, it's okay, you can come in or no, I think you should go to the emergency room. So most things really should be run by their primary care provider first, that way we can avoid lots of hospital visits and ER visits.

Tina S 16:03
And it's another reason to take some time and find a provider, so that you're not having the unnecessary wait in the emergency room. You're not taxing our hospital teams in the emergency room. And you're getting the appropriate level of care, saving money in the process.

Ogechi Anyaoku, MD 16:19
Yes, absolutely.

Nimeet K 16:21
Great. Thank you for that. So we all we ask all our experts on the one thing they would like our listeners to take away from this podcast. So what's you know, what's one of the snippets that you would like to share with the listeners?

Ogechi Anyaoku, MD 16:33
I would say that, I do believe that everyone needs to have a primary care provider, someone that you can go to at least once a year to kind of check on things, make sure everything is okay. And then also, just to be empowered and to be your own advocate. If something does not feel right. If something is, it's not comfortable, you don't feel like you're getting the care that you need. Make a change, seek out another provider.

Nimeet K 16:58
Yeah, that's great advice. I'm hoping my wife is listening to this so she could get a primary care provider. But that's great advice. So thank you for sharing that. I just want to thank our experts today for sharing their insight on this great topic and to find Dr. Anyaoku, please visit AdventistHealthCare.com, and click on Find a Doctor. Don't forget to like and subscribe to Adventist HealthCare & You podcast so you can get all our new episodes. Thank you and be well!