Picture Story on Accessing Health Care!

Hi everyone, 

Below please find instructions and background information to go with the new ESOL picture story "New Insurance, New Doctor" posted here earlier this week.  I am working on finding a web home for the picture story and instructions, but for now this is probably the best way to make it available.  Please share it with colleagues!  Unfortunately I can't add an attachment on this list, so I am pasting the instructions from a Word document --- hopefully the format won't get too crazy in the conversion.

Kate Singleton

ksingletonlcsw@gmail.com

Picture Story: “New Insurance, New Doctor” --- Instructions and Background

This health literacy picture story was created in 2/2014 to help English for Speakers of Other Languages (ESOL) teachers explain basic information to adult English language learners about:

• the Affordable Care Act and how it applies to learners.
• how to use insurance if you are not experienced with it; insurance terminology.
• what non-clinical communication tasks to expect when seeing a US doctor or other healthcare provider for the first time. 
• strategies to improve communication in a doctor’s visit.

The story may also be helpful in other educational and healthcare settings to raise awareness of patients and providers alike to issues of communication, information, culture, and overall mutual understanding that are likely to intensify with current healthcare system changes.

The Basic Story:

Frame 1: Ana applies for new insurance on www.healthcare.gov.  It’s her first time getting insurance.

Frame 2:  Ana receives her new insurance card about a month later.  She is ready to make an appointment for a check-up.

Frame 3: Ana goes to her appointment and presents her new insurance card at the front desk (reception).  She has many questions about how to use the card and what she needs to do now that she is at the doctor’s office.

Frame 4: The receptionist says a lot of things that Ana doesn’t understand.   Ana feels more confused.

Frame 5: The receptionist gives Ana many forms to fill out.  Ana feels even more confused.

Frame 6: Ana is now very confused.  She says, “I’m so confused! Please explain!”

Introducing the story:  

Tell learners they will be working on a story called “New Insurance, New Doctor.” Say that many things are changing about going to the doctor and paying for health care in the US, and the story will help them talk about this.  Ask them what they have done in the past in their native country or in the US to get health care or to pay for health care.  Where did they go?  What did they have to do to get to see a doctor or other healthcare provider?  How did they pay for it?  Ask them if they have had experience with medical forms, insurance, and making medical appointments in the past.  Let them share experiences if they’d like to and their English is up to it.

Vocab to Preteach:

• www.healthcare.gov
• Affordable Care Act / Obamacare
• Insurance
• Insurance card
• Payment, premium
• Appointment
• Receptionist
• Co-pay
• Deductible
• HIPAA (Health Insurance Portability and Accountability Act) --- full name is WAAAY too much info for ESOL learners.  Best to keep your explanation very basic if you go into it at all and stick to info about privacy of medical information. See http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html for more info.
• Medical history
• Forms (you can download examples of doctor office forms and, if your learners are up to it, insurance forms like Explanation of Benefits)
• Confused
• Explain
• Interpreter

Possible Question Prompts and Issues to Discuss for Each Frame:

NOTE --- Because of the complexity of US health care today, discussion of any one of these frames can get complicated quickly!  Please look through the suggested question prompts and issues below and gauge how much info and detail your learners can realistically handle in one class.  For many classes it is advisable to stick to only the most basic questions and issues.

Frame 1: Ana applies for new insurance on www.healthcare.gov.  It’s her first time getting insurance.

            Question Prompts to Elicit Story from Learners:

• This is Ana. 
• What is Ana doing? 
• What website is she looking at? 
• What does she do on this website?

            Issues to discuss (choose depth of questioning according to learner level and ability):

• What is ACA/Obamacare? 
• What is insurance? 
• How can you apply for insurance through www.healthcare.gov? 
• Where can you get help in your community if you don’t understand how to apply for insurance, or if you can get insurance (if you qualify)? (Where are ACA navigators and certified application assistants located?  How can you contact them?)  NOTE: For this issue you will need to do a little research to find contact information for the resources that exist in your area.  A good place to start is the search tool at https://localhelp.healthcare.gov/. You don’t need to know all the ins and outs of applying for insurance, but you will need to be prepared with information to connect learners to people who do.
• Initial open enrollment for Health Insurance Marketplace closes March 31, 2014.

Frame 2:  Ana receives her new insurance card about a month later.  She is ready to make an appointment for a check-up.

Question Prompts:

• What is in Ana’s hand? 
• What can she do now that she has an insurance card? 
• How long did it take to get her insurance card?
• What did she need to do between picture 1 and 2 to get her insurance card? (pay premium)
• How does she make an appointment for her check-up?

            Issues:

• You need to pay a premium before you get your insurance card.
• How do you choose a doctor in your area?
• What kinds of info are on an insurance card? (you can do a Google Images search to find clear examples of insurance cards to show learners)
• What do you do with an insurance card?
• How do you make an appointment with your new doctor?  How long might it take to get an appt.?

Frame 3: Ana goes to her appointment and presents her new insurance card at the front desk (reception).  She has many questions about how to use the card and what she needs to do now that she is at the doctor’s office.

Question Prompts:

• Where is Ana now? 
• It’s her first time at this doctor’s office.  It’s the first time she goes to a doctor in the United States.  How do you think she feels?  Is she nervous?  Is she confused? 
• What questions is she thinking about? 
• Who is she giving her insurance card to? 

Issues:

• What happens at the doctor’s office before you get to see the doctor?
• What is the clipboard on the counter for? (signing in)
• Who is a receptionist?  What does a receptionist ask you to do?
• What does the receptionist do with your insurance card?  Do you have to show any other cards?  Do you have to pay before you see the doctor or after?  How much might you pay if you have insurance?
• How long do you have to wait in the lobby before you see your doctor?

Frame 4: The receptionist says a lot of things that Ana doesn’t understand.   Ana feels more confused.

            Question Prompts:

• Now who is talking?  Does Ana understand the receptionist?  What does Ana hear?  What are some of the new words Ana doesn’t understand?
•  

• Normalize for learners that many people who are native speakers of English have trouble understanding insurance terms, and have trouble understanding people who work in doctor’s offices who are busy and rushing.  Talk about ways you can ask a person to repeat things more slowly or explain things more clearly. 

Frame 5: The receptionist gives Ana many forms to fill out.  Ana feels even more confused.

Question prompts:

• Now what is the receptionist doing? 
• What does she say to Ana? 
• What does she give Ana? 
• Does it look like a lot of forms? 
• What kinds of forms do doctors’ offices give?
• What language do you think the forms are in?

Issues:

• Learner comfort level with filling out forms in English
• Strategies to help with forms:
  • ask for forms before the appt. so you can work on them at home
  • you might be able to get forms online before appt.
  • have a friend or family member with stronger English come to appt. to help with forms
  • ask if any office staff can help you fill out forms
  • ask if interpreter and/or social worker is available to help with forms

Frame 6: Ana is now very confused.  She says, “I’m so confused! Please explain!”

Question Prompts:

• Now how does Ana feel?
• What does she ask the receptionist to do?  Is it easy or difficult to ask this?
• Let’s list/review all the ideas we can think of for how Ana and the receptionist can have better communication at the doctor’s office

Examples:

• Doctor’s office could provide an interpreter for the appt.  Many should for free by law if they receive any federal funding like Medicare payments.  Learner can ask them if they will provide an interpreter free of charge.  Ask them when you call to make an appointment.
• Learner can bring an adult family member or friend to appt. who speaks more English to help with communication.
• Ask for staff to explain things, like Ana does. 
• Ask staff to write down any terms you don’t know so you can get more information on them later from friends, family, teachers, and Internet.
• Ask friends/family who have insurance to explain insurance terms to you before you go to the doctor.
• Audio record your appointment on a smartphone or other audio recorder so you can listen and understand more later.
• Ask for forms before the appt. so you can work on them at home
• You might be able to get forms online before appt.
• Have a friend or family member with stronger English come to appt. to help with forms
• Ask if any office staff can help you fill out forms
• Ask if an interpreter and/or social worker is available to help with forms or communication

No unique issues are listed for this frame as it can be used to summarize discussion of previous frames.