Relevant Book Review "You: The Smart Patient"

I ran across a book called "You: The Smart Patient" by Michael Roizen and Mehmet Oz, who are both doctors. It is paperback and has bright yellow and red cover, if you are looking for it in a bookstore. I bought it and thumbed through it on the flight up to Atlanta this morning. It seems pretty good. It has tips all aspects of being an informed and assertive medical consumer and it is written in a humorous, sometime irreverent fashion, which I like.

This is the process they recommend for dealing with health insurance issues, in escalating order. I thought people here would find it interesting.

1. Start by talking to the healthcare plan rep at the 800 number for your insurance company. Be armed with the technical reason given to your doctor for having denied a claim or whatever the problem is. Ask to appeal the determination. Keep the name and phone # of everyone you talk to.

2. If #1 doesn't work, file a formal appeal. Ask your company and your insurance company to send you all the rules for filing an appeal. Follow those rules to a T. There is a website, http://www.patientsarepowerful.org that has advice about filing appeals. Make sure your appeal contains every conceivable relevant fact. You want to get your appeal in front of a doctor who works for the insurance company, not one of the nurses or clerks. Try to speak to him or her directly. This may take some pushing, but it will increase your chances for success. On average, about 50% of appeals succeed.

3. If 1 and 2 do not work, let them know you are going to take your appeal to the state department of insurance. These folks have a lot of clout. If that does not scare them, then actually take your appeal to the state department of insurance.

MandoJohnny wrote: It has tips all aspects of being an informed and assertive medical consumer . . .

OK, you've shared the part about how to make sure the "doc" gets well paid for everything, but what does the book say that might be useful to me for improving the standard of medical care I purchase? I mean does it provide suggestions about how to best handle dealing with an incompetent doc, or how to conduct research which would enable me to find the best physician in my area practicing any specific speciality?

Regards,
Bill (not being critical, just asking a sincere question)

Yep, it has all that. I just thought that one section I mentioned was relevant to some of the discussions that have been on this board lately. It also has a chapter called "Finding Dr. Right" where it talks about the kinds of questions you should ask a doc and what kinds of answers that should send you looking for a different one. It also has a chapter entitled, "Why You Should Always Get a Second Opinion." Did you know that a second opinion leads to a different course of treatment about 30% of the time? It also talks a lot about keeping your own health history and not depending on doctors to keep good records. Obviously docs should keep good records, but a lot of mistakes are caused by the fact that they don't. The book makes the point that you have to take charge of your own healthcare and not let any providers, including the docs, lead you around by the nose.

The really fascinating section is not so relevant to this forum, but is about avoiding hazards with surgery and hospital stays. It says that a minimum of about 44,000 people die each year from avoidable mistakes in hospitals. The number could actaully be as high as 90,000, though. The book shows how not to be a victim of that.

I'm not saying the book is some be-all and end-all, but it's got some useful stuff in it. Hey, if you are really curious, check out the book for yourself. It's in the bookstores.

I looked at this on Amazon.com, and you can buy it "new" from $8.97 ... if anyone is interested.

Shedahl ... doesn't work for Amazon.com, but likes their prices.

Thanks Mando. I printed this post off and am putting it in my notebook. Plus I will get the book.

Mando stated, "It also has a chapter called "Finding Dr. Right" where it talks about the kinds of questions you should ask a doc and what kinds of answers that should send you looking for a different one."

What does the book say about this answer from a doc? "If you can ask me questions like these, you have too much time on your hands."

jeepdoctor

I don't know what the book says but I say RUN and don't look back