Outsmarting Managed Care: A Doctor Shares His Insider's Secrets to Getting the Health Care You Want

As a former senior director for policy at a major medical insurance company, as well as a practicing physician with some 30 years of experience, Barron is familiar with the bureaucratic complexities of managed-care systems and the frailties of the human beings who run them. In blunt language, his first chapter describes how to evaluate a health-care plan and how to take charge when the plan's practice guidelines deny you the care you want. Be sure to make your physician your ally, he advises, and then, creating a paper trail as you go, work your way up through the chain of command from case manager to medical director to senior medical director. Subsequent chapters shed light on the difficult task of evaluating doctors, when to go to a nonteaching hospital (only when there is no teaching hospital available), when to use and when to avoid emergency rooms, scheduling surgery and other procedures (never on Friday) and interviewing your anesthesiologist. Barron provides cautionary tales throughout to illustrate potential risks and problems, and highlighted boxes encapsulate the key principles he urges patients to keep in mind. While aimed at members of managed-care plans, his sober warnings and practical counsel about avoiding modern health care's pitfalls are equally valid for those enrolled in other kinds of health plans. 5-city author tour. (Oct.)