How can you protect yourself in the era of managed care?

Many people are wondering how they can take advantage of the cost savings of managed care and, at the same time, be protected from its drawbacks. There are ways to avoid many of the managed care pitfalls. You can exercise options most people do not realize they have.

If you maintain your primary medical care outside your managed care plan you may have the best of both possible worlds. This way you keep up a relationship with your own personal physician, typically an internist for adults, responsible only to you. Recommendations for testing and specialty care are not under any particular constraint and will be suggested to you as needed.

If you require the services of a specialist or extensive testing, which is considerably more expensive than the primary care you receive from your personal physician, you can go back to your plan. But you have a primary care physician who is your advocate and has nothing to do with your health plan. When you go back under the umbrella of your health plan, you already know what you need and cannot easily be deterred.

An increasing number of plans are offering what is called a point of service (POS) option, because people have been demanding it. This provision covers patients going outside the plan, but requires that they pay more than they would under the plan. Even without this option, the patient can still see whomever they choose, if they are resourceful. Your safest position in the current health care environment is to have a personal physician who is your ally, beholden only to you. It is actually possible to come pretty close to having your cake and eating it too.

You can also get a periodic thorough evaluation through a physician not in your plan. Depending on your age, this might be at one to three year intervals. This way, you get the comprehensive detailed examination which had been available from your physician prior to the advent of managed care. Patients who are not having problems with their health care plan but wish to have a thorough periodic screening examination may also contact Dr. Robinson at the American Health Advisory Center.

The approach to your health care outlined here is analogous with the way you use your automobile insurance. Routine maintenance and periodic servicing are not usually covered by insurance. But if you have a crash with a lot of damage you are protected. Not everyone follows the manufacturers recommendations for checking their brakes, steering, timing and all the other systems which make up an automobile. Some wait until the engine is making funny sounds, there is weak acceleration, and black smoke is belching out the back end. Those are personal choices.

If you want to get an idea how many things are done in a routine servicing of your automobile or truck, take your owners manual out of the glove compartment and look at the 30,000 mile servicing list. The human body is vastly more complex. When a physician takes an hour with you, the check list is far longer than the one for your automobile. The complete medical examination is analogous to that 30,000 mile servicing but requires greater resources to perform properly.

In health care, it pays to take charge and be sure you are doing all the periodic preventive maintenance. This reduces risk to your health and well being while increasing your peace of mind.

Contact DrRobinson@MD-1.com for further information.
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