Ten Steps For Surviving Managed Health Care

by Dr. Emmett Miller

Even Time magazine agrees the best way to cope with the managed care system as it is today is to not get sick. No wonder Americans pumped out $600 million last year for alternative health services; services which as a whole stress preventive measures. Preventive medicine doesn’t just mean eating right and exercising, it means taking total responsibility for your own health. It means educating yourself about your body and mind, developing healthy daily routines, even making a change in lifestyle. Here are ten steps to managing your own health care, steps that will increase your odds of not having to step into an HMO.

Ten Steps That Will Really
Make You Feel Better

1. Become aware that you are responsible for your own health. Most illnesses are in some way preventable, either through caution, mental attitude, or lifestyle and diet changes. There is no one else to blame if you lose your health and without a familiar trusted, family doctor, no guarantee you can even get good quality help in regaining it. So if you really want to be healthy, you have to live healthy on a daily basis.

2. Understand the physical health of your body is a reflection of your life. Your body and the shape it’s in are the products of your thoughts, feelings, behaviors and habits, as well as such unalterables as genetics and past injury.

3. Understand your attitude is the ultimate source of good health. Your philosophical approach and outlook on life are your best medicine. Your deepest beliefs, your spirituality, put into action by your emotions, are the prime movers, the ultimate source of your physical strength.

4. Gain access to higher levels of yourself. This is done through entering a state of consciousness in which the body is relaxed deeply and the mind has been emptied of distracting thoughts and brought to a laser-sharp focus. This will help you get in touch with your deepest beliefs, spiritual strengths, inner wisdom and your vision of where your life is going.

5. Examine your self-esteem and what might be suppressing it. Develop an awareness of self, and an appreciation and valuing of who you are. Develop confidence in the guidance provided to you by your self-healing self. Understand there is a level of yourself that is full of self-healing wisdom, and this level deserves your trust, support, consideration and perhaps obedience. This, in effect, puts you in charge.

6. Learn good habits of eliminating accumulated stress through deep relaxation. Stress accumulates over time and then places a larger and larger burden on your system — edging you toward loss of health and stress-related diseases. It’s necessary to take a little time to deal with stress. Frequent breaks, relaxation and proper sleep are necessary.

7. Learn to listen to your emotions. Explore your emotions as barometers of inner needs. Feel them fully, understand what they are telling you — rather than resisting, blocking or avoiding them. Your emotions are your body’s way of communicating its needs to you. It is your deeper mind’s way of letting you know it has unfinished business with something. This is done by relaxing and allowing emotions to guide you to the images or memories that underlie the specific emotions you feel.

8. Practice taking control of “involuntary” neuromuscular reactions. Many of our body’s inner workings are affected by our mental and emotional states and can be controlled through much practice. Being able to relax and lower your metabolic rate could save you at the time of a heart attack. Learning to relax your muscles could relieve a headache or backache. Learning to decondition harmful responses of your mind and body can prevent their recurrence. You can change habit patterns such as eating, smoking, and food abuse through the use of mind tools.

9. "Don’t go there." Just as an alcoholic learns that in order to stop drinking at a certain bar he need only remember "don’t go there," we learn that we must not dwell on certain situations if we don’t want to "feel that way." By learning how to empty your mind of unnecessary thoughts you enable yourself to stay focused on your goal. Once you have decided on the correct course of action at the wisest level of your mind, eliminate distracting thoughts on an ongoing basis, just by saying to yourself, "I’m not going there."

10. Create a healthy self-image. Now you are ready to focus toward the future. Most valuable is creating a healthy self-image. Do this by re-evoking the experience of joy, enthusiasm, strength, energy, safety, love, etc. — exemplified by one or two memories from your past. These are reference memories that will produce the positive emotions which will be your high energy fuel for creating the mind, body and life you want. While supporting this emotion within you, during the deeply relaxed state, visualize your image ideal — your body as healthy and imagine, successfully engaging in deeply rewarding activities. Visualizing this with the inner conviction that nothing stands between you and what you really want and rehearsing the future behavior you want greatly increases the likelihood of its taking place.

In much the same way that a dog who receives frequent lessons and rewards soon learns to walk at "heel," the deeper levels of your mind gradually become more trained.It’s almost as if the mind learns to "heel," to go where you guide, to aim where you aim…thus healing yourself deeply and developing a life which is truly successful.

But as we know, even those who do take care of themselves sometimes get sick or have accidents that require the services of hospitals, and doctors. Ultimately, that means dealing with managed health care systems such as HMOs. Many people are reluctant to join HMOs, but are more reluctant to go without medical insurance. If this sounds like you, what can you do? What are the steps you need to take to prevent medical problems of the financial and legal kind, and guarantee you get the best medical care when it is needed the most?

The problems of HMOs are the problems of our society, and won’t just go away. We need to be forewarned and forearmed, which means being an educated consumer.

Ten steps to help you choose best HMO program

1. Be assertive. Many find it disconcerting to interview a physician. They have a kind of stage fright around doctors. They still think "Doctors are like Gods." To them I say, "Get over it." This is the 1990s. You are the employer and you are hiring an employee, your physician, who will be responsible for the most important thing in your life, your life — and in an emergency may be your only access to life-sustaining procedures.

2. Interview the doctors you might choose. Look for a physician who is open to the kinds of complementary treatment you might want to have; i.e., chiropractic. See what their views are on mind/body medicine. Are they open to giving patient information so you can be more in charge of your health? Is this a compassionate person — the kind you would want treating you when you are sick? These are things you want to know.

3. Shop around. If you have an HMO through your employer, you must make-do with it, as most people do. If, on the other hand, you have the opportunity to choose among HMOs, you can ask the same questions you would ask a prospective doctor. Is this the kind of company you want treating you when you’re sick? After all, they are not all alike. You may even learn some important information while shopping around which will help you weigh your options.

4. Read the fine print. The first order of business should be to determine exactly what the plan covers. Some services, such as mental health treatments, drug rehabilitation or dental care, may not be included at all. Young families should look for obstetric and well-baby services; older families for rehabilitative and home care services. A prescription medication you depend on may be deemed too expensive. If there are too many exceptions in the fine print, the company may be looking for ways not to pay. Exclude them before they exclude you.

5. Ask about their policy towards “pre-existing conditions,” “experimental” and “medically unnecessary” treatments. These reasonable sounding exceptions can prove to be dangerous, even fatal, sticking points in the hands of an incompetent HMO bureaucrat. The patient could be liable for all costs relating to even such a common pre-existing condition as high blood pressure, as well as for new ailments that may stem from the original illness. Bone-marrow transplants, or AZT for HIV-positive patients are commonly accepted in the medical community, but some HMO’s exclude them as "experimental." "Medically necessary" is a phrase that is open to interpretation — and it is important to know by whom. They often say, "The Patient Advocate determines the medical necessity" but this advocate may be some bureaucrat whom you will never meet. "Medical necessity…is the managed-care gold mine."

6. Look beyond monthly premiums to consider overall costs including copayments and deductibles. Will your prospective HMO set a reasonable limit on what you have to pay out of your own pocket every year? Plus, some plans have a lifetime limit on what they will pay, which can be wiped out by one major health problem. Look at the long-term financial picture.

7. Find out if you have your choice of doctors. Can you choose a doctor and then change that doctor easily if you are unhappy with the care? Are these doctors allowed to make referrals? What percentage of the plan’s doctors are board certified in their specialties? Be sure to talk with someone who is authorized to answer your questions, like the plan administrator. Also, keep notes of your conversation, including the name of the person and the date and time called.

8. What if something goes wrong? Is there a patient advocate? A complaint line where someone actually picks up the telephone? Is there a way to appeal? Individual companies and the National Committee for Quality Assurance (NCQA), an industry group, also put out patient satisfaction surveys, but these are not very reliable. Has your prospective HMO passed the NCQA certification procedure? (The NCQA findings are free to anyone who calls 202-955-3515 or checks the organization’s web site, at www.ncqa.org.)

9. What is the relationship between your doctor and the health care company? This can affect what the doctor tells you and the care you receive. Did you know some doctors receive special incentive plans that pay them a bonus to keep costs down? Some arrangements involve set monthly fees which can discourage a physician from going past a certain spending level. And according to the American Medical Association, at least a dozen HMOs, covering millions of patients, have so-called "gag clauses" that prevent doctors from revealing their compensation deal or discussing treatment options that are not covered by the plan. Yet it is nearly impossible for a single consumer to find out about these arrangements. Try to get answers through your employer, who has more leverage. Any plan in which doctors are forbidden to discuss treatments not covered by their company can be hazardous to your health in the event of a serious illness.

10. Don’t feel stupid if you don’t understand. Ask questions, re-frame them if you don’t understand the answer. According to Dr. Eugene Ogrod, president of the California Medical Association, in a recent article in Time magazine, “Some of the information is more complicated than the rental agreements for your condominium. Even physicians working in the plans sometimes have difficulty understanding what they mean.” Perhaps knowing this will reassure you while getting the runaround it’s not just you.

Given this list of options, you may want to go back to the first ten steps and study how to stay out of HMOs and managed health clinics in the first place.

Dr. Emmett Miller is the author of Deep Healing: The Essence of Mind/Body Medicine (Hay House 1997). You can obtain his “Let Go of the Stress” meditation tapes by calling Source Cassette Learning Systems at 1-800-52-TAPES.

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