Adulting 101: How to Schedule Check-Ups, Doctor Appointments, and Navigate Insurance
When it comes to moving, there is one thing I dread above all else.
It is finding new doctors and dentists who take my insurance, accept new patients, and are great caregivers.
It is astounding how difficult it can be to schedule an appointment. But check-ups and preventative care are so important. And I can’t tell you how many people I’ve talked to that know they have a condition of some sort, but delay getting help!
In one study, they found that “not undergoing health check-ups is a predictor of cancer diagnosis and advanced cancer stage.”₁
And with all the hoops to jump through to even see a healthcare professional, it’s little wonder we delay. But the longer the delay, the worse a condition typically becomes.
If you also have felt overwhelmed by trying to find a healthcare provider, I’m here to smooth out the process for you! I’m going to hold your hand and walk you through how to find a provider, what appointments I recommend you schedule, and how to work with your insurance.
I know it’s not glitzy, but we are going to make it as fun and useful as possible. So let’s dive into adulting 101!
Your personal healthcare team line-up
First of all, let’s talk about the medical peeps you should probably see regularly
Primary Care Provider
Also known as a PCP. This is the doctor that performs your annual check-up and unless you see a specialist, is your go-to when you get sick or need medication.
For almost every single kind of insurance plan, the annual check-up (often known as a “well check”) is 100% covered by insurance, meaning it’s at no cost to you.
However, be warned that if your doctor ends up treating you for something else during your annual check-up, you likely will be billed. Now, if you have an issue, DO bring it up, but I just want you to go into it knowing that you likely will pay for it.
You will need a doctor that treats adults, as well as pediatricians for your children. Some doctors are considered family doctors and treat both adults and children.
Dentist
You should be seeing a dentist once every six months. The cleaning and teeth inspection help get tartar off your teeth and can prevent gum disease. And even though we aren’t really sure why, gum disease has long been linked to heart disease.
I’m not saying you are going to develop a heart condition if you don’t see a dentist for a year, but oral health is really important, not to mention an essential part of hygiene (news flash, decaying teeth, and bad breath are not very attractive).
Again, for almost every insurance plan, dental check-ups are 100% covered.
Your children will need to see a dentist who treats children as that requires a little extra tender love and care. But like doctors, some treat both adults and children. Or you can find a pediatric dentist for just them.
Most children are ready for the dentist at about age 3. If you want to take them in earlier, that’s fine of course. I took my two year old in and she was NOT ready. However, they were able to look in her mouth just to be sure there wasn’t anything concerning.
The number one issue teeth issue for children is putting them down with a bottle because it bathes the sugar from the milk on the babies’ teeth. When my son was really little, we always had him drink his bottle propped up on his pillow and bed, but we simply started brushing his teeth in bed (since he couldn’t spit yet) after he finished and that worked great for us.
OBGYN / Gynecologist:
In case you’re curious (because I was) a gynecologist is a doctor who specializes in women’s reproductive health. An OBGYN, on the other hand (obstetrician-gynecologist) also specializes in women’s reproductive health as well as pregnancy and childbirth.
These doctors will give you your annual pap smear test (if you’ve had children it’s not so bad, if you haven’t, it’s worse).
Pap smear tests are important because they check for indicators of cervical cancer.
Dermatologist:
Dermatologists specialize in your largest living organ - your skin! Schedule an appointment once a year so they can screen you for skin cancer, as well as chart any moles or irregularities with your skin.
By charting them, they will be able to see if any abnormalities happen over time.
Optometrist:
It’s a good idea to get a yearly eye exam, whether or not you wear glasses. According to Harvard Health, “Women are more likely than men to have eye conditions that lead to vision loss!” 2
Your primary care doctor may be able to provide these eye exams. However, if you do have eye issues, you probably should go visit an optometrist once a year, or at least every other year.
Many insurance plans cover a yearly check-up so if you don’t currently need glasses, you shouldn’t need to buy vision insurance just for an annual check to make sure your eyes are working right!
Other providers to consider adding to your team
Therapist
One of my good friends sets appointments for her children with a therapist once they become teens. Her purpose in doing this is to normalize therapy and to provide another space place for her children to talk and get help if they need support beyond their mom.
There are several different kinds of therapists, and sometimes it’s confusing to know which one to see!
Counselors: Usually hold a master’s degree in counseling. They give therapy and help people learn coping strategies, enhance their quality of life, and improve relationships.
Psychologist: Hold advanced degrees (usually a Ph.D.) and specialize in human behavior, thoughts, and emotions. They can diagnose and give counseling/therapy for lots of mental health issues. However, they do not prescribe medication.
Psychiatrist: A medical doctor who specializes in mental health. They can diagnose mental disorders, prescribe medication, and give psychotherapy (counseling, therapy).
Physical therapist
I hate to break it to you, but most likely you are going to have some muscular issues at some point.
I can’t tell you how many times people have told me they have chronic pain in their back, knees, hips, or whatever that they have NOT had it checked out. Young people, old people, so many different demographcis.
For these issues, physical therapists are my GO-TO.
I love that they assess the WHY behind an issue, and not just try to treat the cause (far too many doctors are medication and surgery trigger-happy).
If you have an issue with your knee, it’s going to bleed into issues with the rest of your body. Everything is connected and it can culminate in a domino effect. So if you have issues, get help.
After my son was born, I developed a crazy pain in my back. I was able to find out I had issues with a muscle called my quadratus lumborum, and that I needed to strengthen a muscle called my transversus abdominis. It was SO helpful.
Years later, if I start to feel pain in that part of my back, I know what to do! The knowledge has paid dividends.
I have seen a physical therapist for diastasis recti, pelvic floor issues (after my second child was born) and for TMJD issues (jaw problems), and every time I have learned SO much. And while YouTube can be helpful, there actually were several exercises there for my jaw that my physical therapist actually asked me to avoid for a time because the motions were making things worse.
If you need help beyond typical muscular issues (like pelvic floor and TMJD), be sure that your physical therapist has the specialty you’re looking for.
I have also heard lots of good things about chiropractors and they are similar to physical therapists in their goals, but their methods are different. Typically their focus is on muscular issues related to the spine, joints, and nervous system. They also typically use manual adjustment techniques. Just be sure that their goal is to “work themselves out of a job,” meaning their goal is to get you well and out of the office, not as a chronic patient forever.
How to actually schedule appointments and a few things to be aware of
To avoid the overwhelm, here is my process for finding healthcare providers and actually getting an appointment on the claendar.
Get recommendations. Often doctors have reviews online which are helpful, but the best way to find a provider is by talking to friends, family, neighbors, co-workers especially (since they likely have the same insurance as you) people in your community to find providers you like. After having a pretty bad experience meeing with a provider I haphazardly found online, I reached out on a community facebook group for some recommendations and it was so helpful. Get as many names as you can because they may or may not take your insurance.
In general your insurance will have a provider portal. Create a login and search for the providers you were referred to. I am praying that some day this will be better, but for now, it is what it is. Oftentimes, the provider will take your insurance, but I have found that insurance provider portals are often outdated. You can call your insurance, or check the provider website (or call them) to see if they accept your insurance.
Call the doctor or dentist appointment and get something on the calendar. Note that new patients usually take the lowest priority. Once you are an established patient, many offices can get you in the day of if you’re sick, but until then, you usually are scheduled MONTHS out. So for this reason, get on the calendar as soon as possible. This is the same story with dentists, although some providers will see you. For instance, I couldn’t get into my dentist for 9 months for my first check-up/cleaning, but I did have an issue with my tooth and they were able to get me in for just that. They have to triage.
You might know you need to see a specialist, but in most cases, you will need a referral from your primary care provider.
Navigating insurance
Isn’t it hilarious that if you go to a store you know what the price of each item is, whereas if you are getting medical help you have NO CLUE?
It’s messed up, I know. One thing that can help is to ask for billing codes in advance. Billing codes are labels that describe the service you are getting and magically translate into a cost when you call your insurance.
For example, say that you go to your doctor for a check-up. They find something abnormal from a blood test and want to get further testing done. You could ask in advance for that billing code, call your insurance, give them that billing code, and then they will be able to tell you what the cost will be before you get the service done.
I am not advocating forgoing an important medical test, visit, or procedure because you don’t like the cost, but knowing the cost will set proper expectations, help you make a decision if the procedure is elective, and if the cost is too high, you can look at alternatives. For example, blood work done in hospitals is typically more expensive than that done in a regular doctor’s office.
Also be aware that some things that honestly “should” be covered, simply aren’t. For example, many insurance plans do not cover infant “helmets” which correct an irregular head shape. They claim that these are cosmetic.
This was the case for us.
My infant needed a helmet and it was incredibly expensive without insurance. We were told we would need to completely cover the cost as starving college students, we were very discouraged. We found a great provider’s office, however, and they fought for us. I don’t know exactly how they did it. I had called and talked to the insurance several times with no luck, but then they took over and helped us.
We had been working with a different helmet doctor’s office earlier and they were no help, so it was definitely not a smooth journey.
But in the end, it was worth the trouble of making all the phone calls and switching doctors.
Don’t be afraid to ask lots of questions. Also know that if the insurance gives you a denial you can appeal it, and ask your provider to help show the necessity of your treatment.
Now, be wise financially, but even if insurance doesn’t cover something, if it’s necessary, please consider the health tax.
The health tax refers to what you end up paying later on in terms of health if you don’t take care of yourself now. For example, if you don’t invest in exercise or the minimum equipment to help you exercise (like running shoes) you end up paying more for healthcare due to chronic diseases later on.
So even though it can be a bummer, sometimes you just have to swallow the cost to take care of your body.
Captaining your own ship
One day I was doing dishes when I got a phone call. My doctor’s nurse told me that the results from my routine blood work had just come back and that one of my thyroid hormone levels was abnormal. I was taken aback and asked lots of questions that she wasn’t able to answer. She told me simply that they would repeat the test.
After fretting quite a bit for 8 weeks, I went back to repeat the lab. This time, the doctor herself called to tell me the results were still abnormal. I asked a lot of questions and she didn’t seem to make much effort to answer, instead, she gave very roundabout and vague answers. It was evident she did not know much about the thyroid.
I asked if her she was concerned about it. She said “not necessarily.” I asked if I should see a specialist, “not necessarily.” She told me she would prescribe medication and that I would likely be on it for the rest of my life. I asked if the medication had bad side effects. “no more than other most medications.” That was it. The end. Finally, I gave up. I was super frustrated. I did a lot of my own research and talked to friends in the healthcare field.
When I got the actual numbers back I was shocked to find that my numbers were barely in the abnormal range. However, I insisted on seeing a specialist and was given a referral.
My specialist was great, and as of right now no medications are needed. I learned a ton, got peace of mind, now know what to look out for and I’m so grateful I didn’t just hop on the medication train when my doctor had no idea what she was even giving me.
Even though a doctor’s opinion matters, you have to own your own health. The current Western healthcare system is also known as “sick care” meaning we treat symptoms of sickness instead of taking a holistic approach and preventing.
We prescribe medications and surgery without trying to fix the underlying issue. The best doctors are much more progressive and adopt a more preventative strategy and treat the whole person.
Search for those doctors, advocate for yourself, and shop around. At the end of the day, you are the expert on your body.
Well my friend, thanks for sticking with me. I hope you are feeling confident and ready to take on finding and scheduling your own appointments with your doctors and healthcare providers so you can receive the treatment you need, prevent any unnecessary heartache or pain down the road, and have more peace of mind.
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