The word is out—your company plan has changed benefit options and the only health insurance choices are "managed care programs."

   Or perhaps you are a Californian who has been using Medi-Cal Insurance, and you have now been officially notified that the entire program will now be subject to "managed care."

   Health insurance is something that a lupus patient must never take for granted, and if you have adequate coverage, you should do everything you can to maintain that same coverage. But circumstances change, marriages sometimes fail, and there is nothing permanent about permanent employment positions. Sooner or later, most employment ends; and oftentimes, so does the health insurance coverage.

   I do not claim to be an expert in health insurance—but I have discovered a few helpful hints that I would like to share with those who might be facing a change to managed care health insurance—or perhaps just a change to a new primary care physician.

   Several years ago I faced this change—and with great fear. My fears were all justified as physician choice #1 and then #2 both assured me that I knew more about lupus than they did. Choice #3 also readily admitted she had never treated a lupus patient before but was very open to discussing my suggestions about running the tests I felt were necessary, openly reporting test results with me, and referring me to a specialist when we both agreed it was necessary. What more could I ask?

   From a negative standpoint, I was depending upon my very limited knowledge of medicine, as a layperson, to make recommendations to my primary care physician.

   But from a practical, positive standpoint, this transition period taught me to be a very assertive patient, to ask a lot of questions, to take responsibility for my own illness, document my symptoms and complications very carefully, not to fill every prescription I was handed until I researched the drug, and to learn as much as I could about the problems I was experiencing.

   Even if you have a private practitioner whom you trust implicitly, you might consider becoming a more active participant in managing your own health.

REVIEW AND INTERVIEW THE PRIMARY CARE PHYSICIAN CHOICES

• carefully review the choices of primary care physicians
• consider those "candidates" who are most likely experienced in the treatment of lupus—usually rheumatologists or internists
• if you live in Northern California, request the current Medical Referral List of Primary Care Physicians
• call the physician's office and ask the nurse if the doctor has had a lot of experience treating lupus patients

   If the nurse says "yes," don't hesitate to ask how many lupus patients he/she is currently following. If the doctor follows less than six, unless you live in a very remote area, I would try to locate a physician who has had more experience with lupus if your health plan has other options.

THE 15-MINUTE GET ACQUAINTED OFFICE VISIT

   If the physician and the health insurance provider allows, ask to make the "first appointment" a brief 15 minute appointment as "get acquainted visit" prior to having all your medical records changed and submit to the time-consuming and expensive history and physical examination that usually occurs during the first office visit.

   Most physicians would be willing to allow this if the patient is prepared and only takes fifteen minutes. Be sure you do not abuse this privilege if you can arrange this for your first visit—otherwise the physician being considered may feel imposed upon if he/she falls behind schedule and will probably not come across as the congenial physician you are seeking.

   Make the most of those brief 15 minutes and hand him/her your prepared medical fact sheet that briefly summarizes your past and current problems with lupus.

   Prior to the office visit, rehearse what you plan to cover during this first visit, make notes and refer to them, and allow enough time for his/her questions and your responses.

   Observe the office environment, the staff and how they seem to relate to you and the other patients. Hopefully, you will leave with a positive impression and decide this is a "fit."

   If you eventually decide you cannot adjust to this new primary care doctor and feel you need to change physicians, most insurance plans allow at least one change a year.

ANOTHER OPINION

   Your physician should not object to you asking for another opinion. It is your right to make this request when you feel it is necessary. Many times another medical opinion may give you the assurance you need about a diagnosis or treatment plan your primary care physician has recommended. Ask your insurance carrier representative about options for consultations.

THE MEDICAL RECORD FACT SHEET
Never Leave Home Without It

   Whenever you have a doctor's visit, whether it be your first or 50th visit, update your medical record fact sheet, take it with you and hand it to your doctor.

   This fact sheet should contain:

• all your current prescription medications, strength of the prescription, and the dosage you were prescribed
• also include any over-the-counter medication, vitamins or mineral supplements you might be taking
• complaints since your last medical visit, describing how you were affected and how long the problem occurred
• list your current symptoms or concerns
• any requests for lab tests or any referral you feel you may need
• any questions you may have

   This medical record sheet will prompt your doctor to ask you about some of these pertinent facts if you should forget to verbally report them. And this process saves so much time—it alerts the doctor to the most important issues.

   You may indeed feel foolish the first time you hand this sheet to your doctor. But after a few office visits, your doctor will begin asking you for it.

IN CONCLUSION

   One learns so much about themselves and how to relate effectively to the physician who treats them when they take more responsibility in their own healthcare management. There is so much you can do to avoid being mis-managed in today's changing healthcare system.