End of life care has made vast improvements. However, statistics show that aggressive high cost care for patients continues to be widespread. Costs in end stage medicine continue to be extensive and sometimes physically, emotionally or financially exhausting for patients and their families. We find that this doesn't always necessarily offer the patient quality of life care or address the patient's actual wishes until too late. We continue to see very Ill patients in and out of the hospital or rehab units for their final weeks to months of life. We continue to struggle to identify the patient's wishes and goals until they are hospitalized or in crisis despite many advances in establishing advanced directives. In the old saying "We know more about our refrigerators than about our health insurance," many individuals do not understand their insurance and may feel quite overwhelmed by this complicated process. Rhoda Neader's book "Case Management: A Palliative Perspective" includes basic insurance resources for anyone interested in learning more. It is a must read tool for case managers, nurses or anyone wishing to know more about the insurance maze. It offers a well more comprehensive approach for anyone in their patients or their family's end of life experience.