Don’t you talk back to me! (Or, why this *isn’t* always advice worth taking!)

I think it was often the look on my face. I can’t really remember ever “talking back” to an adult, but it’s hard to imagine any kid not wanting to at some point. I suspect there must have been something on my face that indicated I wanted to “talk back” that caused my grandmother or my dad to shake a finger and issue that warning.

It turns out that there are some times though when talking back might actually be a good thing.

Many counselors are trained in a technique called mirroring, when they repeat back (sometimes paraphrasing, sometimes word for word) what their client has just said to them. While some people may experience that as annoying (is there an echo in here?), it can also be a way to demonstrate that a person has been listening. read more

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.
  • read more