Advice from a nurse case manager

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Don’t be afraid to ask questions about cost, or care.

Carolyn Espinoza talks nearly every day with people who are worried about their health care costs.

They want to know: “How much will this cost?” “Is this test expensive?” “Why is the bill so high?”

Espinoza, who has worked five years as a nurse case manager for Regence BlueCross Blue Shield of Oregon, encourages patients and their families to ask lots of questions because that’s the best way to ensure high-quality, cost-effective care.“There are some really standard things people can do as far as health care costs,” she says. “One is knowing what your options are. And to be aware that there is usually more than one solution.”

For example, if someone takes a prescription from her doctor to the pharmacy and then realizes she can’t afford the medication, she can go back to the doctor and ask for an alternative.

“That is always, always OK,” Espinoza says. “The doctor may not be able to sub in something else. But at least it starts the dialogue about making sure your health needs are met.”

Espinoza, 34, began her career as a certified nursing assistant in a long-term care facility. She went on to become a registered nurse caring for cardiac patients in a critical-care unit and, for a time, she managed cases at a skilled nursing facility.

A married mom with three children under age 12, Espinoza sought a job that allowed her more flexibility. She also wanted a change because she was frustrated by inefficiencies within the health care system and seeing how consumers often bore the brunt of the added costs.

Today, Espinoza works from her home, communicating with patients and their families mostly by phone and email. Her role is to be the patient’s advocate, which includes helping people find the right doctor, ask the right questions or understand complex medical jargon and insurance rules.

“The most satisfying part of my job is the ability to build long-term relationships with people,” she says. “Sometimes, as a nurse, you just see little snippets of people’s lives, whereas with nurse case management, we get to see the outcomes and see good things happen to people.”

The types of cases Espinoza handles vary. Some patients have been sick for a very long time. Others have had little experience within the health care system until they suffered a stroke, were involved in a car crash or experienced some other catastrophic event.

No matter what they face, Espinoza encourages patients and their families to take an active, educated role in their care.

Ask why the doctor has ordered a particular test. Ask whether the results will go into a file or directly affect care.

Her advice: “Patients who have the power to ask the tough questions – Why does this cost so much? What am I going to get for my money? – People who do that, in general, are going to get a better quality of care and a happier health care experience because they know what they’re getting and then they know where they’re going.”
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