The Good, The Bad, and The Ugly About Dr. Google

(Hint: It’s not personal.)

There is no question that the internet has been the most important tool to ever empower patients with knowledge and information to make informed choices about their health and healthcare. Some have even given it a nickname of sorts, “Doctor Google.” It’s the first place many of us go when we want to learn about a health issue, and the information that’s now available to us can help us ask better questions, and have a more meaningful conversation with our doctors. Still, as helpful as information can be, sometimes too much of a good thing (or too much of the wrong thing) can lead us down a rabbit hole. read more

Appeal Your Insurance Denial Successfully!

You’ve reviewed the letter from your insurance company that says they’re not going to pay for a service you or a loved one has already had. When the rage has cooled and you re-read the letter, it states the reasons they denied payment, which may or may not make sense to you. Terms like “Didn’t meet medical necessity” or “More information is required” or “Pre-authorization wasn’t submitted.” It may reference pages in a document you’ve never seen or heard of but sounds important. read more

Should you appeal your insurance denial?


Carla’s* mother had been hospitalized for a week for a hip replacement, and discharged to a skilled nursing facility for rehab. Three weeks after her admission, she received a notice that her mother’s Medicare plan was denying payment for her care because she wasn’t participating in therapy. 

Dave* had foot surgery that required the implantation of a new type of manufactured material. The surgery had been pre-approved, but his insurance denied payment for the manufactured material.

Elena’s* ovarian cancer had advanced, and her oncologist felt that the next medication she should try, which in his experience had shown some good results, was only FDA approved for breast cancer, not for ovarian cancer. Her insurance denied coverage for the use of this medication. read more

Making Hard Medical Decisions

Back in the glory days of black and white television, Dr. Welby walked into a hospital room, provided a diagnosis, and told his patient what to do. As patients insisted on more of a role in decisions that affect them, often we now find ourselves in the position of our physicians providing options and asking (rather than telling) us what we want to do.


On the one hand, shared decision making is an important part of informed consent. On the other though, many patients find themselves thinking, “I’m not a doctor. How could I know what’s best for me?”


While the answer will be different for every patient, there are two tools often used to facilitate coming to a hard medical decision you can feel good about.


The first is comes from the book by Jerome Groopman and Pamela Hartzband, Your Medical Mind. How to Decide What is Right for You.  They describe 3 scales of how we perceive healthcare.


Here’s the graphic:


Understanding how you feel about these perceptions is vitally important in assessing options that your physician presents to you. Keep in mind though, that where your perceptions are today, may not be where they are tomorrow. It’s OK, for example to find that where you might once have been aligned with a more technological orientation, for a given situation you may find yourself leaning toward a more natural orientation. The key is simply being aware of what feels right to you for the decision you have to make.


The second tool that can help with tough medical decisions is called the Ottawa Personal Decision Guide (OPDG). Developed by the Ottawa Hospital Research Institute in Canada, this tool helps people identify their decision making needs, plan the next steps, track their progress, and share their views about the decision with other people involved with their care.


While not everyone will want to write down their responses to the questions this guide poses, it can be an extremely useful tool to frame a decision based on your values, goals, and expectations. It helps to identify gaps in order to make a decision whether they’re related to knowledge, clarifying values, or identifying support that’s needed to make a decision that works for you.


Studies show that patients that are engaged in decisions about their healthcare are more satisfied with their overall care than patients who simply defer to their doctor. If you were thoughtful in making the best decision for you you could at the time, there’s less chance of experiencing those dreaded “I wish I had….” feelings.


One last thought: If it’s not an emergency, take your time! Even if you sense your doctor wants you to make a decision in the moment, if you’re not comfortable, you can always step back to re-assess, and schedule another appointment when you’re clearer on what else you need to know, as well as the downstream effects of your decision.


Medical decision-making can be daunting, but it doesn’t have to be. An independent patient advocate can help.

Health Insurance: Test Your IQ

What you don’t know might cost you!

The air has already gotten a bit crisper on some of my morning walks. While that may mean apples and candy corn for some, it also signals open enrollment for health insurance for many of us.

We have the most complicated healthcare system in the world, largely because of the role insurance plays. Insurance is a legal contract and for non-attorneys, the language is crazy-making if you even read the fine print (and most of us don’t).

Knowing even a few key things about health insurance can make the difference between feeling in control and finding yourself facing unexpected bills.

OK, it’s not as sexy as the Top 10 places to travel in 2019, but if you want to test yourself on our Top 10 Health Insurance Questions to see how you stack up, give it a try!


Test yourself. True or False?


  1. If I don’t follow the open enrollment instructions for my plan, my coverage could be dropped.


  1. If I don’t have health insurance, a hospital is obligated to care for me without charge.


  1. If I miss a monthly premium payment, I can make it up next month.


  1. Long Term Care Insurance is the same as Long Term Disability Insurance.


  • I can add a family member (spouse or child) to my insurance coverage only during open enrollment.
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    Hospital Discharge: Could it be a bit more hospitable?

    I may be one of the few people on the planet who invested my second language studies in Latin. And yes, it probably would have been more practical to study a language people actually speak!

    While having a working knowledge of Latin has been helpful for crossword puzzles, at other times my intellectual curiosity simply gets the best of me. A recent call about a hospital discharge experience piqued my curiosity about where the words “hospital” and “patient” and come from. Hospital comes from the Latin word “hospes,” which essentially means a guest or stranger. It’s also the root for words like hostel, and hospitality. “Patient” comes from the Latin word “patior,” to suffer. So from these Latin roots it’s easy to understand why we might consider hospitals to be “a special place of care for guests/strangers who are suffering.”

    This word study also sheds light on why some hospitals have become more “hotel-like” fueling our expectation that they have an obligation to take care of us when circumstances prevent us from taking care of ourselves. At the same time with the increasing cost of care and demands on hospitals, especially at discharge, too often we experience them as not such caring places.

    Marilyn’s sister, Annie,* fell on a Saturday afternoon. Annie had been disabled for some time from multiple sclerosis and depression, but was living alone in her own apartment. Marilyn called Annie’s primary care doctor, and was told to go to the nearest ER. Annie’s ankle was broken.  Instructed not to put any weight on her leg, as she was being discharged, the nurse gave her the name of a medical supply company to order a wheelchair, and scheduled Annie to see an orthopedic surgeon late the next week.

    Marilyn was panicked. Annie’s apartment wouldn’t accommodate a wheelchair, and the only shower was in a bathtub. Marilyn worked full time and knew that Annie would not be content to sit on the couch all day, unable to get to bathroom on her own, or to stand to prepare food. And the accident had really made her MS symptoms and depression worse.

    She asked the emergency room doctor why they were sending Annie home – after all her ankle was fractured, she was obviously going to have to be in a wheelchair and there was no one to take care of her at home. Wasn’t the hospital responsible for keeping her until arrangements could be made?

    Being treated in the emergency room isn’t the same as being admitted to the hospital. While hospital emergency rooms are mandated by law to provide care to anyone who walks in the door without regard to their ability to pay, they don’t have a legal obligation to manage or support what happens after that care is delivered.

    In Annie’s case, after the usual wait to be seen in the ER, she was X-rayed, and a diagnosis was made. A splint was applied, and a follow up doctor’s appointment was scheduled. Thus endeth the ER’s obligation to Annie.

    The fact that she lived alone, and that a wheelchair wouldn’t get through the front door was essentially immaterial. Marilyn and Annie were on their own to figure out what to do. Unless.

    Unless Annie had been admitted to the hospital after she was seen in the emergency room. Let’s say she needed immediate surgery on her ankle. She might have been prepped for surgery and taken straight from the emergency room. Surgery completed, she’d be taken to a room and her in-patient care would begin.

    In this case, when the hospital admitted Annie for in-patient care, modeled largely after Medicare guidelines, most assume an obligation to make sure that the patient has a “safe discharge.” While this is an ethical standard, the laws governing this vary from state to state. So as you might imagine, what exactly defines a safe discharge is somewhat open to interpretation.

    Hospitals have to evaluate the capacity of the patient to make an informed decision about their care, whether a patient has a reliable caregiver at home, and if not, what other resources can be applied to assure the patient’s safety. It’s a complicated process. Patients and their caregivers want to be prepared, but this report from Kaiser Health News makes clear it’s the exception rather than the rule.

    If a hospital discharge has been “sprung” on you or a loved one, and you know there will be issues with safe and adequate care consider these options:

  • If you are being discharged from the emergency room without being admitted, expecting the hospital to help with care at home may not be realistic. Still, they may have a social worker for the emergency room that can help put a contingency plan together.
  • If you’ve been admitted, start thinking about what’s going to happen when you leave the hospital sooner rather than later. Discuss your living situation with the medical team, as well as involving family and friends in the discussion.
  • While you may not know exactly what care will be needed, ask to meet with the discharge planner assigned to your floor. Usually a licensed social worker, these professionals can help patients and family understand options and build a care plan. Click here for some guidelines on how to approach this.
  • Try to negotiate additional time with the treating physician. While hospitals can’t keep patients indefinitely, if it is taking more time than expected to make care arrangements, sometimes the treating physician can justify a patient staying an extra day or two before discharge.
  • Don’t be surprised if you get a list of options from a hospital but no real recommendations. Hospitals are often pressured to discharge patients quickly and the burden of completing a care plan falls on the family. Identifying the best medical equipment supplier, rehab facility or home care agency and support can be daunting. If a discharge feels premature or unsafe, or you need help evaluating options, a private patient advocate can help.
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