I agree with you goldie that it seems a little much to keep a 3 ring binder, however, when done well, managed care can save a lot a money through negotiated fees with providers. We paid all of $10.00 for my and my son's $25,000 hospital bills. If we had been on a standard 80/20 plan we would have had to pay $5,000. I would rather keep a binder and make some phone calls than pay $4,990.