Conference back40::soapbox

I manage to care often!

    I have found it very useful.  Three dollar copays help when you have
    three children and a wife who requires over $300.00 monthly in
    prescriptions!
    
    -Jack

    
    
    my wife was pregnant when we started working for digital.
    when she had an appointment with her o.b. she informed the
    secretary that she had a new health insurance carrier (an hmo)
    and that we were dropping our old third party payment plan.
    
    the wife delivered a beautiful baby and about three weeks later
    we got a notice that the old carrier was being billed.  i called
    up the old carrier, told them that my wife was covered by an
    hmo and that they should not make a payment.  i then called the
    doctor's office, clarified the mistake, making sure that the 
    secretary would correct the situation and bill the hmo.
    
    things were very hectic in my life, two kids in diapers, a new
    job etc. so in the absence of hearing anything more, i presumed
    the payment was made.  
    
    two years went by.  we got a phone call from the o.b.'s office
    saying that the old carrier had stopped payment and that we were 
    responsible for paying for the doctors bills.  i freaked out
    (the bill was $2000) which at the time was a little less than
    we had in the bank.  i told them again to bill my hmo.  they
    got back and told me that the hmo would only honor services 
    submitted within a six month time span.  we were served legal
    papers by the doctor saying that we had to make payment.  
    
    at first glance it would have appeared that the o.b.'s office
    was to blame since it never submitted the bill.
    had i had some real money in the bank i would have fought it.
    but there was another kink.  the $2000 was only the o.b.'s bill?
    who covered the hospital expenses?  i called the old carrier
    and my hmo and neither had made payments.  yikes.  if i contested
    the o.b. i could lose, have to pay lawyers expenses and potentially 
    reveal the fact that the hospital costs had been dropped on
    the floor.
    
    i chickened out and sent a check with $2000 to the doctor with
    an explanation and an appeal to be fair.  he cashed the check
    and never replied.  that was ten years ago.
    
    lesson learned:  hmos remove you from the paper loop but leave
    you exposed to situations like these.  whenever large medical
    expenses are incurred i always check the hmo and doctor's office
    to ensure that requests for payments were submitted and received.
    
    
    
                         

JUST SAY NO TO HMO'S  (High Mortality Organizations)

	An HMO is basically an insurance company that, oh by the way,
happens to have some employees that know some medicine.  The first
level of focus is on being an insurance company.  The second level of
focus is on public image.   The third level of focus is to get people
to heal themselves.   Since an HMO is basically an insurance company,
the health care you receive is driven by statistics.  If it is a common
problem for a person of your age/weight/history then you have a better
chance of getting proper medical care.  If you have an uncommon
problem, then the HMO could let you die and it wouldn't hurt their
statistical image in the community.

	HMO's have not really done much to cut costs except to
themselves.  They have stopped paying Malpractice insurance because
the insurance company is a self insurer.  They don't really pay any
kind of medical insurance at all.  Think about it, how much less
would your medical care cost if you did not have to pay for insurance.
They buy the most common drugs at bulk rate and prescribe them in such
small quantities that they still make money.  They have their
lifestyle or pain management or weight loss or yoga or whatever else
they offer at times when the majority of people can not use them.

	Insurance has never ever helped me get healthy!  Insurance
really doesn't do anything except pay for things other people do.  And
the insurance industry really isn't any good at paying for things
anyway.  Insurance, as an industry, has FAILED.  I do not need any
insurance, sometimes I need health care.

	Gee, my uvula problem is not a common one at all. Yet they did take it
out, and offered me two ways of doing it. One is going under the knife, the
other is surgery. It was left totally up to me to decide. It cost me a whopping
$5! I can't see how that is something bad.

	In the summer last year I had a knee problem. It was quite aggervaiting
when they did not call me to go see the specialist. But then again, it had
happened before I had an hmo, too. It was a hassle when the specialist couldn't
explain to me what I wanted to know. But that happened before I had a hmo as
well. It was great that the physical therapist explained it all to me and
through therapy my knee is fine. What do i chalk the aggrivation stuff up to?
Certain people in the place itself. Not the hmo. Oh yeah, that one cost me $65.
$5 to see my doctor initially, and $5/therapy session. I can remember paying
much more before just because I went into the emergency room with a sprained
ankle. $100 deductable! Sorry..... I will take an hmo anyday.


Glen

    
    >offered me two ways of doing it. One is going under the knife, the
    >other is surgery.
    
    All right, explain to me the difference between these two ways!
    

    One is while your awake???
    

 With all the stuff my youngest son went through this year, I am quite 
 pleased with my HMO in general.  We had one spat, but when I was able
 to convince them that I was not satisfied with their suggested response
 to his most recent hospitilization, they backed off and went along with
 our requests 100%.



 Jim

| <<< Note 683.6 by POWDML::HANGGELI "Little Chamber of Full Body Frisks" >>>


| All right, explain to me the difference between these two ways!

	DOH! One is a laser, the other is a knife.... where the hell is my
brain? I think I will describe two seperate ways of doing something using the
same method.....sigh...thanks, Deb for catching that.

    haven't had many problems with the HMO I am currently on, except that I
    have past, negative histories with almost all their OB/GYN's, directly
    and indirectly.  The old HMO was a "slow-payer" which caused me no end
    of grief with one particular ER.  I also had problems with referrals a
    few times.
    
    The biggie I have found with HMO's and all medical plans, for that
    matter, is to become an informed consumer.
    
    meg

	Well, seems as though I have a bad story about an HMO. Last night at
volleyball a friend of mine broke his finger. So we were in Cambridge, so I
took him to the Mt Auburn (sp?) hospital. They were starting the process of
looking at him when the lady said at some point he should call his HMO. So he
did inbetween sitting in the waiting room, and seeing a doctor. Well, while he
was with the doctor, they called. They said they would not pay for the hospital
as that was not his primary care facility. He had to go to Emerson to have it
looked at. Emerson is about 15 miles away, with a ton of traffic lights. So off
we went to Emerson. They took care of everything, but to have to leave a
hospital where he was getting care, to go to another hospital, is ridiculous.
He has Harvard. 

	But part of this is his fault, as well. He lives in Boston, but for
some reason has an Acton mailbox that he has all of his mail go to. So the HMO
has his address as Acton. Had it been Boston, there might not have been a
problem. 


Glen

    
    	We have been extremely happy with our HMO.
    
    	5 years ago, during open enrollment, we switched from John
    	Hancock to an HMO.  2 weeks later, we got a call from my
    	husband's doctor that changed our lives drastically.
    
    	Since then, my husband has easily surpassed $200,000 in medical
    	treatments.  With John Hancock, we would have paid at least 20%.
    	With our HMO, we have paid a few copayments, probably less than 5
    	at $5.00 apiece.  We have seen some of the best doctors in the
    	country, and all his care has been out of MGH and MEEI.
    
    	When we encounter problems, it is usually an issue like an
        incorrect address on the referral.  
    
    	The keys to good HMO service and care, at least in our HMO:
    
    	o Find a good, caring Primary Care Physician with a responsible
    	  staff
    
    	o Educate yourself on the referral procedure
    
    	o Bring copies of your referrals with you to your doctor visits
    
    	o Follow HMO procedures 
    
    	o Call the HMO's customer service when you have a problem.  THEY
    	  will take care of calling hospital billing offices, etc. to 
    	  let them know payment is being addressed.
    
    	o Get names of anyone you talk to at Customer Service.
    
    Karen
    
    	

    
      Love my HMO.  I will never go back to the other, no way.
    
      My dependents like it, too.
    
        bb

	I am glad so many of you are happy with your HMO's.  I can't really
say that I've had even 1 good experience with any HMO in Mass.

	On New Years Eve, my wife was having difficulty breathing.  I called
the HMO and they advised an emergency room visit.  We arrived about 8PM. There
were 2 other sets of patients in the waiting room.  One was a couple who were
looking for a pregnancy test, the other was a mental patient with a large gash
in his head.  We were asked to wait.  While we were waiting, another couple
came in.  Both were elderly.  The man believed that he was having a heart
attack again.  After about 2 hours waiting and 2 cans of ginger ale, he and
his wife left because he felt a little better.  Ginger ale relieves gas
problems.  My wife, the bleeding patient and the potentially pregnant couple
were still waiting.  At 11pm, my wife was taken in.  The man with the gash in
his skull was still there. He had soaked the gauze with blood and was forming
a pool on the floor.  The bleeding patient was taken in at about 1:30am and
the couple for the pregnancy test were still there when we left at 3am.

	My wife was diagnosed with bronchitis and given an antibiotic.  The
antibiotic was the only one that she has difficulty with when she takes it.
She had informed the doctor that it was a problem as had I and he argued that
this particular brand was not the same as the rest.  About a day an a half
later, I rushed my wife to another doctor, who diagnosed the problem as an
asthmatic spasm.  Within hours she was fine.

	There are more instances of problems.  Each of them were followed with
a complaint to the customer service department.  The last time I talked to
one of the presidents and he assured me that, in 6 months, there would be a
new affiliates program that would provide better care.  Digital and other
corporations in Mass have found problems with HMO's and have begun a collective
review methodology.  I gave them my views during the inception of their program.
I've decided not to risk my life or anyone elses with an HMO and have not gone
back.  We haven't had a single problem with health care since.

After 25 years with traditional insurance programs I joined and HMO.

8 years and running, I'll stick with the HMO. Lots of great doctors (some
not so great, but reporting them gets them moved on), better 
results, no paperwork, no hassles, same day appointments, covered 
prescriptions, and on and on ...


Doug.

re .14:

You went to an emergency room and waited a long time and had some other
problems there.  How would it have been different if you hadn't been in
an HMO?

re: .16

	I would not have gone to the HMO related hospital.  There were other
better ones between home and this one.  By itself it really doesn't show a 
problem but when it is put together with the other instances it clearly
indicates a systemimc problem.

>You went to an emergency room and waited a long time and had some other
>problems there.  How would it have been different if you hadn't been in
>an HMO?
    
     Details, details! Don't bother me with the details!

Oh, they told you which ER to go to!  You didn't say that in your note.
Did you ask if you could take her to a different ER?  What's your HMO?

	My wife and I have been trying to have children.  We started seeing
the HMO specialist in this area.  The doctor opted not to run any tests on
either of us and went directly to insemination with fertility drugs.  He had
us read and sign a waiver that said he had explained the side effects of the
drugs.  He had said that there were essentially none.  My wife had a reaction
to the drug.  The doctor said it was in her mind.  We requested a different
doctor.  The HMO did not have any other doctors and offered a nurse
practicianer that worked for the doctor we did not like.  We rejected this
outrage and they told us that we would have to get an appointment with a
doctor outside the HMO and request the referal.  We followed their procedure.
We were continually informed that the meeting for the referals was in 2 weeks.
Always 2 weeks.  The day before the appointment (4 months later) the HMO had
not reviewed the request yet.  We told them we were going anyway.  Then they
refused to pay.  We went to the doctor who reviewed the HMO procedures and had
talked to them about what they did.  None of it made any sense.  The doctor
gave us a general discription of how an insemination should be performed per
the AMA and the best clinics in the nation.  This was no where near what the
HMO had done.  In fact, what the HMO doctor had done actually reduced the
chances of having children.

    My biggest complaint about our HMO is in trying to get a referral
    (so that another doctor can be paid by our insurance.)

    They won't give a referral without a doctor visit with our primary
    physician (even if you explain why you want the referral and there 
    is nothing the primary physician can do about the matter you want 
    resolved by a specialist.)

    It takes up to a month to get an appointment with the primary
    physician for a pointless examination so that you can BEGIN to try
    to get an appointment with a specialist.  It could be another month
    or two to get an appointment with the specialist, of course.  So the
    time spent waiting for the primary physician appointment (for the
    useless examination which is really just a formality in order to be
    allowed to ASK for an appointment with a specialist) is a total waste.

    I've gotten to the point where I most often pay for the doctor visit
    myself (and bypass the HMO altogether.)  If I need antibiotics, I go
    to the nearest Emergi-care and pay with a credit card for the visit.
    My HMO card still helps me get the medication at a good price.

    I'd rather drop the HMO and buy good hospital insurance so that we're
    covered for major illnesses.  We can afford to pay for our own doctor
    visits.  I think the HMO is pretty useless.

    
    	I think the difference is in making an informed decision
    	before signing up for an HMO.  Know what hospitals your
    	HMO uses, and make sure you'd be willing to go there for
    	treatment.  Take a good look at its doctor list.  Ask
    	everyone you know what HMO they are in, and evaluate their
    	inputs (a high rating of an HMO by someone that has not needed
    	much care is not worth much, nor is a bad rating by someone
    	who doesn't follow procedures).
                                           
    

While I find .4 by NICOLA::STACY to be ridiculous, I can agree that
some HMOs in MA to which I was a member for a short time, were less
that stunning in their performance (as bad as non-HMO doctors I'd seen, and
these where supposed to be some of the best doctors in the region).
 
It was for this reason I was very reluctant at joining a new one when I
moved to NH. 

It would have been a major mistake had I not joined with my current provider.

Doug.

re: .19

	I thought all HMO's told you where to go if you called in before going.
This HMO plan always refers the patients to the same hospital.

    
    
    	CMHC has been fairly decent to our family over the years. The worst
    one we had was John Hancock. What a joke...
    
    
    jim

re: .22

	The ratings do not really matter.  I did the homework prior to joining.
The HMO I belong to is one of the highest rated ones in the nation.  It does
have a good list of both general and specialty doctors.

    again, you didn't say what hmo you belonged to.
    
    i had an occassion to go to the emergency room once, and it was not the
    hospital to which i belonged.  no problem.  it cost 25$, but hey, there
    were no snags and the hospital was convenient (in location).
    
    it sounds like ::spacy is having problems with the doctors WITHIN the
    hmo, not the hmo itself.  if that's the case, look into another hmo,
    one with better doctors, or at least ones you like.
    
    my biggest gripe is when i need a referal.  my pcp is pretty good about
    it, sometimes.  if i have had a history with a problem, i can call and
    request a referal and they mail me one (or to the other doctor's
    office).  if it's a new problem, it is a pain to go in and have an exam
    for something you know the doctor won't be able to do anyway.  i also
    have no problem getting my referals to the eye doctor or the dreaded
    female doctor.  
    
    the only other gripe i have is that it would be nice to be be covered
    if i am going to a hospital anywhere that accepts the type of insurance
    i have
    
    other than that, i have been pretty happy with my hmo.
    
    

 I was fortunate in that the doctor we've had since we moved to New England
 and were on John Hancock, is also in the HMO to which I now belong.




 Jim

    RE: .27  Raq

    Your HMO sounds wonderful compared to mine.

    > my biggest gripe is when i need a referal.  my pcp is pretty good about
    > it, sometimes.  if i have had a history with a problem, i can call and
    > request a referal and they mail me one (or to the other doctor's
    > office).  

    It doesn't matter if I need to see a specialist about a problem I've
    had since birth, my primary care physician requires an appointment with
    him first anyway (even though he's already examined the problem before
    and he KNOWS he can't do anything about it.)

    > if it's a new problem, it is a pain to go in and have an exam
    > for something you know the doctor won't be able to do anyway.  

    I quit an earlier primary physician we had because I went to him
    with excruciating pain in one knee and he refused to give me x-rays
    (or a referral to an orthopedic surgeon within our HMO.)  I had to
    go through the HMO's administrative offices to get approval (by
    absolutely insisting on it) to see the HMO's own specialist.

    > i also have no problem getting my referals to the eye doctor or the 
    > dreaded female doctor.  

    Our HMO flatly refuses to give referrals for ObGyn examinations.
    The primary physician knows how to do that stuff, so there's no way
    in hell they will approve a visit with an ObGyn (even though they
    have such doctors within their HMO - in the same building as the
    primary physicians.)

    Once a year, our HMO allows a 'well visit' which can be used for a
    yearly physical.  If you want to see an ObGyn (and you aren't pregnant
    or dying), the only way to see one is to use the yearly 'well visit'
    (which means skipping the yearly physical.)

    I hate all this beyond words.  If a woman on an HMO wants a yearly
    checkup with an ObGyn, she shouldn't be forced to give up a general
    yearly physical in order to do it within the HMO.  This probably
    isn't how it works in most HMOs, but this is how it works in mine.

    
    it's interesting how the managed care model has so quickly 
    altered practices.  just a few years ago one could never
    get a doctor to diagnose you over the phone much less initiate
    a prescription (not a renewal).  recently a chest cold prompted
    me to call my pcp.  he was too busy to even talk to me on the
    phone.  i ended up getting a prescription from his nurse 
    (again, all based on phone conversations, not a visit to the office).
    in some ways this makes life simpler for minor and common ailments,
    but i wonder how this new way of doing things will affect those
    with potentially serious problems.
    

>Note 683.27                   Managed Care Stories                      27 of 30
>GAVEL::JANDROW "i think, therefore i have a headache"  25 lines  18-MAR-1996
>--------------------------------------------------------------------------------
>    again, you didn't say what hmo you belonged to.

	What does it matter what the name of the HMO is?  I've actually
belonged to 3 different HMO's.  Two were in Mass and one was in Minn.
The one in Minn was tiny and was probably the best HMO I've seen.  The ones in
Mass were large and both were problematic.  I don't need any problems from the
HMO monster darling of the state because somebody takes something I write in
here and is irresponsible with it.


>    it sounds like ::spacy is having problems with the doctors WITHIN the
>    hmo, not the hmo itself.  if that's the case, look into another hmo,
>    one with better doctors, or at least ones you like.

	Thanks for calling me names.  Try to read the notes again.

    
    	Jim,
    
    	I didn't say to go by the ratings.  I said to talk to people you
    	know.  People that can give you real life experiences.
    
    	We use Tufts.
    
    	Karen
    

| <<< Note 683.21 by SPECXN::CONLON >>>

| It takes up to a month to get an appointment with the primary physician for a 
| pointless examination so that you can BEGIN to try to get an appointment with 
| a specialist.  

	Whenever I needed an appointment, I call up and 9 times out of 10, I
get in that day. The only time I ever have to wait a long time is if I want a
physical. I call for that at the beginning of every year, and get in around
February or March. 



Glen

| <<< Note 683.24 by NICOLA::STACY >>>


| I thought all HMO's told you where to go if you called in before going.
| This HMO plan always refers the patients to the same hospital.

	Is it Harvard? :-)

 ZZZ    Thanks for calling me names.  Try to read the notes again.
    
    Chill out.  It's a term of endearment in this place.
    
    My heart just flutters every time Raq makes a nasty inuendo to me.  Try
    it...it just might work for you!
    

    >I don't need any problems from the HMO monster darling of the state 
    >because somebody takes something I write in here and is irresponsible 
    >with it.
    
     Take it to the conspiracy/paranoia note.

    
    actually, i did not mean to call you ::spacy...honest.  i have a friend
    with that last name and everytime i see ::stacy, i read it as ::spacy.
    it was not meant as an insult.  it was i typo.  i'm sorry.
    
    
    and a few back:  with my pcp, on a couple of occassions, i have called
    in and described my symptoms and, after the nurse talked to the doctor,
    i received prescriptions without having to go in (it was to combat a 
    sore throat accompanied with a cold).  if the doctor is questionable
    out it, he asks me to come in.  and i find it rather convenient, saves
    me a some time and money.
                                                              

re: .35 and .37

	I said Thanks!!  What do you want??  Flowers?

    The best way to find complete satisfaction with your health care
    provider is to avoid all medical care.  Do everything in your power
    to stay healthy.  Maybe that is what HMO's are trying to sink into our
    thick skulls ?

    >The best way to find complete satisfaction with your health care
    >provider is to avoid all medical care.  
    
     No, the best way to find complete satisfaction is to set up a system
    wherein services are provided without regard to cost- make the
    government pay for everyone and institute no rationing or any sort of
    cost controls. Ask Stacy, he'll tell ya.

    
    fine.  be that way.
    
    next time, i won't apologize for an error that was taken for an insult.
    

| <<< Note 683.38 by NICOLA::STACY >>>

| I said Thanks!!  What do you want??  Flowers?

	You don't bring me flowersssss.....anyyyyymoooooorrreeeee

>================================================================================
>Note 683.40                   Managed Care Stories                      40 of 41
>WAHOO::LEVESQUE "contents under pressure"             7 lines  18-MAR-1996 14:35
>--------------------------------------------------------------------------------
>    >The best way to find complete satisfaction with your health care
>    >provider is to avoid all medical care.
>
>     No, the best way to find complete satisfaction is to set up a system
>    wherein services are provided without regard to cost- make the
>    government pay for everyone and institute no rationing or any sort of
>    cost controls. Ask Stacy, he'll tell ya.

	Typical conservative!  Tell everyone what somebody else thinks!  Almost
the first thing I said was that "I DON'T NEED INSURANCE, SOMETIMES I NEED
HEALTH CARE".  Insurance companies are a private industry that has FAILED! It
should go the way of the EDSEL.  The only thing that keeps them in existence
is that they most people frightened to do without them.  I don't expect them
to change soon, but about 40+ million (I think this number is right but would
need to confirm it) people in this country are not insured.  Is that because
the insurance doesn't provide value for them?  I believe that there are 2 or 3
expensive diseases in most lives on average.  There are 1 or 2 that we survive
and 1 that kills us.  I can pay for all the other medical help out of my
pocket.  It would even be easy if it weren't for the malpractice insurance
adder to the cost.  All I need is an insurance investment program that smoothes
out the expense of those expensive illnesses over my lifetime.

    re: Oh, they told you which ER to go to!  You didn't say that in your
    note.  Did you ask if you could take her to a different ER?  What's
    your HMO?
    
    My HMO (starts with a "K") never gave me any trouble with this.
    I had to rush Kyle to the ER one time.  The only hospital around
    here isn't in the plan.  I told kaiser (oops) what happened and I
    had to send the co-payment to them.  They took care of everything
    else.  (but they told me they'd like for me to call before.  I said
    "I'll remember that").
    
    MadMike
      
    

>[health] Insurance companies are a private industry that has FAILED!

Go figure? What have they failed at?

    Trying to understand the system a bit better...
    
    If I read this right - you have the choice of obtaining your own
    private coverage or an HMO, right?  Do you also have to pay premiums to
    the HMO?  And then, you only get to go the doctors/hospitals that 
    that particular HMO is affiliated with?  What part of the cost is
    covered by Digital's benefits?  And what about unemployed people - do
    they also belong to an HMO?  What happens if you need a Dr. and you are
    out of visiting range to your local provider?
    
    As somebody who lives in a country where you can go to any
    doctor/hospital at any time and have the basic costs covered, I find 
    this topic very interesting.  The doc raises a valid question with 
    respect to cost control.  I'd like to see Canada adopt a policy whereby
    a $10.00 charge was billed to the individual for each appointment - might 
    stop some of the hypochondriacs who feel the need to go to the walk-in 
    medical clinics umpteen times a year.  Then, of course, there would have 
    to be another solution for welfare/unemployed cases - maybe some kind of
    voucher?  I don't know - it's a difficult quandary

An HMO is a health insurance provider, like any other, except that it is
affiliated with specific health service entities. They have contracted with 
certain health service entities at a pre-defined price, with a pre-defined 
set of rules for executing that service.

The goal is to provide the necessary service in an efficient, cost 
controlled/managed manner.

If you insure through an HMO, your coverage is limitted to the HMO rules.
This means getting service from doctors,hospitals, and pharmacies which
have contract with the HMO. In order to use services by providers outside
the HMO, you must get a refferal (justification) from an HMO doctor.

The insurance premiums are generally paid as part of you work benifits.

Doug.

    
      Ah, yes.  Socialized medicine, the liberal wet dream.
    
      bb

Oh yes, you are covered just like regular insurance when you are outside the
region for that particular HMO. This so that if you break your leg in California
and you live in NH, you don't have to fly back to have the cast put on :-)

Doug.

re: .47

>The goal is to provide the necessary service in an efficient, cost 
>controlled/managed manner.

	The goal is to MAKE MONEY!  To do that they need to convince healthy
people to stay and non-healthy people to go.  How do you think they manage that?

Those goddam dirty capitalist swine ...

    RE: .47   Doug     

    > If you insure through an HMO, your coverage is limitted to the HMO rules.
    > This means getting service from doctors,hospitals, and pharmacies which
    > have contract with the HMO. 

    This sounds like it might be ok on the surface, but some HMOs have
    limits which are much tighter than this.

    > In order to use services by providers outside the HMO, you must get a 
    > refferal (justification) from an HMO doctor.

    In my HMO, it's next to impossible to get a referral to go INSIDE the
    HMO without going through a visit to the primary care physician.

    Even if you go through the primary care physician, they flatly refuse
    to give a referral to an ObGyn doctor in the same HMO (same group,
    same building) because the primary care physician is 'qualified' to
    do Gyn exams as a 'family health practitioner'.

    It doesn't matter what you want.  It doesn't matter that the other
    doctor is part of the same clinic as your primary care physician
    (and part of the same HMO.)

    They only let you have this visit if you trade a 'well visit' (which
    is supposed to be used for a yearly physical) for the Gyn visit that
    you really want.

    Does it make any sense to hold such restrictions within the HMO itself?
    (I don't think so.)

    
      re, .46 - well, if this is really an info request on current
     healthcare conditions in the US, here's a few brief points :
    
      Prior to WW II, Healthcare in the US was cheap.  Doctors were a
     grossly underpaid profession, and nobody went into medicine to
     make money.  The quality was generally simple, no-nonsense, and
     by modern standards, abysmal.  General practitioners made up over
     90% of doctors, and the common mode was the "house call".
    
      During and after WW II, some US businesses began offering medical
     insurance as a benefit.  The US government joined in, making it more
     advantagous from a tax perspective to offer coverage than pay.  As a
     result, during the 50's, virtually all the big US corporations offered
     partly or fully paid health insurance.  Labor unions fought for, and
     won, coverage.  This tended to leave out the self-employed, the poor,
     the elderly, and the rich.  Health care has always been private here.
    
      In the late 60's, during the LBJ administration, the federal
     government instituted two programs : Medicare, which covers the
     elderly, and is partly covered by a direct payroll tax, like social
     security, except unlike social security, the tax is much too small
     and is supplemented from general revenue.  And Medicaid, a directly
     funded government healthcare insurance program for those on welfare.
     These are entitlements : they are not subject to congressional budget
     decisions each year, but are automatic.  At that time, liberal
     Democrats, who were over 2/3 of the US Senate and over 60% of the US
     House, insulated the programs from politics, built in cost-of-living
     increases, and began slowly to borrow the money by issuing bonds.
    
      And that's the way it stands.  The ragtag system of insurance and
     government programs still covers the vast majority of Americans,
     but not all.  But now, the demographics are inexorably catching up
     with this "system", and at the same time advances in medical science
     have made possible extraordinarily expensive treatments for diseases
     which used to result in death.  Healtchare is now one of our largest
     industries, nearly 11% of GDP, the highest in the world, and with a
     growth rate which is obviously unsustainable economically.
    
      There are many proposals, all terribly expensive, put forth by
     members of both parties, but none has been adopted yet.  At the
     same time, health care costs have threatened major US corporations
     with severe financial problems.  Part of the attractiveness of
     automation and downsizing is that robots don't get sick.  For the
     first time, the uncovered portions of the population has started
     to increase.  Companies often require physicals as part of hiring.
     They are less worried about your qualifications than about whether
     you will get sick.
    
      bb

RE: STACY
>	The goal is to MAKE MONEY!  To do that they need to convince healthy
>people to stay and non-healthy people to go.  How do you think they manage that?

If the managed care folks can reduce the insurance premiums and provide good
health care AND make a profit then more power to them. As for "and non-healthy 
people to go" I have seen NO evidence of this here, and in fact, if you are 
a digit, they cannot refuse you for any reason.


re: CONLON

>    This sounds like it might be ok on the surface, but some HMOs have
>    limits which are much tighter than this.

  All HMOs, just like health insurance companies, are different. You should 
  chose one only if it suits your needs. 

>    In my HMO, it's next to impossible to get a referral to go INSIDE the
>    HMO without going through a visit to the primary care physician.

  I have had a multitude of referals inside and outside of my plan. Many 
  times only requiring a phone call to my PP. The requirement for approval 
  by the PP is a good one. If you don't like your PP decisions, change 
  your PP. If you don't like your HMO, then change carriers or take other 
  steps to change the situation.

  Doug.

re: .54

	I have been refused treatment at the HMO!  Since I was refused
treatment, then what am I paying for?  Your note sounds reasonable and I am 
absolutely certain that HMOs want people to believe what you are saying.
HMOs are BIG BUISNESS!  They are INSURANCE COMPANIES!  There is no level of 
altruism in that buisness.

	I have a very rare medical problem.  Not life threatening if it is
treated and it is easy to treat.  It is VERY PAINFULL.  The last I knew there
were 5 of us in the world.  The treatment is basically a modification of 
bee sting medicine and is very very cheap.  It is non-narcotic and nobody
anywhere is abusing the stuff.  Uneducated doctors are most likely 
to treat the condition improperly and that can cause harm.  I can tell the
pharmicist how to mix the medication.  The HMO will not contact the specialist
I refered them to to learn about the condition and they will not provide the
medication.  Basically I don't count.  I can't hurt their statistics.  I get 
NO healtcare even though I pay the premiums.

    That's what we have open enrollment for.

    
    	I agree with Mark.  
    
    	There *are* good HMO's out there.
    
    

    Unfortunately, you can only choose HMOs which are available where
    you happen to live.

    We are considering abandoning managed care altogether and buying
    medical insurance (privately) which will cover us for accidents 
    and major illnesses (including transplants, etc., up to $1,000,000
    per illness.)

    This won't cover doctor visits, but I've been stepping outside the
    HMO for doctor visits for awhile anyway.  We don't actually have
    that many office visits in a given year anyway.
    
    We're thinking about our options.

Have you looked into HMO Elect?

>	I have been refused treatment at the HMO!  Since I was refused
>  treatment, then what am I paying for?  

 Digital has a mechanism for dealing with situations just like yours. Is 
 DEC paying for your insurance? Use these guys and fix the problem.

>Your note sounds reasonable and I am 
>absolutely certain that HMOs want people to believe what you are saying.
 
 Not all HMOs are as you describe ...

re: .56, .57, .59, .61

	As I said in a note much earlier.  I do NOT GO TO HMOs at all anymore.
I've been in 2 HMOs in Mass.  Both highly rated.  Both with the same disrespect
for the patient.  It was a long effort to get the problem diagnosed and to find
the treatment.  I have been through the HMO service and the Digital service for
problems.  Bottom line, my health is more important than money and it costs a
lot to go to court.  So for now I just make it loud and clear to JUST SAY NO TO
HMOs (High Mortality Organizations). Some day shortly somebody is going to take
an HMO insurance company, not a doctor, to court for malpractice.  I thought
they were getting close with the day-birth mandates.  They are very close in
some of the other areas like oncology, gynecology and by the phone
prescriptions.  Right now they are settling out of court, but not every
statistical insignificance can be silenced with money.

    There are good and bad doctors, there are good and bad HMOs.  Even HMOs
    that have a good reputation in one part of the country can have a
    horrible reputation in another.  The key is to get Digital to allow us
    to choose the good HMOs.  Remember, the rules for HMOs vary from
    state-to-state.
    
    In Dallas, Digital only gives us two choices for HMOs; one that is
    pretty good, but expensive, the other is cheap, but has 8 times as many
    wrongful death suits filed against it as any other HMO, has twice the
    annual physician turnover, and is the only HMO in Dallas that is
    actually losing members.  When we complained about the incredible rate
    increase of the first HMO for the HMO and HMO-Elect plans, Digital said
    they would look into having the cheap HMO provide the HMO-elect plan in
    the future.  What IDIOTS!
    
    Bob

>                              When we complained about the incredible rate
>    increase of the first HMO for the HMO and HMO-Elect plans, Digital said
>    they would look into having the cheap HMO provide the HMO-elect plan in
>    the future.  What IDIOTS!

I'd prefer it if a good HMO were the HMO Elect HMO where I live.  That way
I'd stay in-plan more often.

I once had Fallon tell me I had to drive from the Marlboro Hospital emergency
room to St. Vincent's in Worcester in order for them to cover it. "It" being
the left index finger that didn't work because I had a pretty deep cut just
in front of the knuckle. I ended up hanging up on them. A specialist surgeon
was called in to stitch the tendon (she used a low power microscope!), and
she managed to convince Fallon that they wouldn't have been able to deal with
it anyway... They paid.

On the other hand, I have a gastro-intestinal problem that requires the
presrciption form of the "acid-blocker" medication that recently became
available over the counter. ~ $1/pill at a drugstore, I get them for $5/60.
This might have changed now that it's been released.

I have a couple of other stories, but the bottom line is:
HMOs - Don't have emergencies.

    
    The best antidote I have found for poor HMO's is the Medical 
Walk in Center, if you can stand paying twice for treatment.  

A few years ago, between October and December, I had 
bronchitis 4 times followed by what I was sure was 
pneumonia.  My HMO doctor (who canceled my two emergency 
visits) said that there was nothing wrong but a bad cold 
and if I still felt ill in a week to call her again.  

I immediately tried to schedule an appointment with her 
for a weeks time but was told her book was full for two weeks.  
So, I went to the local walk in clinic, was examined, xrayed, 
diagnosed and treated, and given enough free antibiotic 
samples to cover treatment, all for $98.00 dollars.
It was pneumonia and the doctor said it wouldn't have waited
a week let alone two weeks, which my doctor would have heard 
if she had examined my chest.  He gave me the xrays and 
said I had a good legal case if I chose to pursue it.  

The same thing happened again the following winter, other 
trips to the walkin clinic became necessary as the same HMO
doctor thought there was nothing unusual in a patient having 
multiple cases of bronchitis and pneumonia 2 winters in a 
row.  That doctor eventually left the HMO.  

Finally, with a new doctor, I eventually got proper 
diagnose and treatment for the real problem behind the problem.
I guess I was lucky, it only took 8 years to get the
correct diagnosis and treatment.  

    re: .64
    
    Yep.  But not all the specialists I use are in the HMO, so with
    HMO-elect, I at least get some help with the costs.  If the cheap HMO
    were to become the HMO-elect provider, I'd have to go outside of the
    network all the time.
    
    I understand there was an article in the WSJ yesterday about a study
    that supposedly found a direct relationship between the strictness of
    an HMO's formulary and the frequency of patients recurring medical
    problems.
    
    Bob

    We experienced our 1st botched job from our HMO.  The doctor, not our
    usual pediatrician, prescribed an antibiotic for our 7 month old
    daughter's ear infection.  When my wife went to fill the prescription,
    the pharmacist questioned the dosage.  My wife called the HMO to
    verify this and was told (by a nurse) that the stated dosage was correct.
    
    Ten days later our daughter's recheck shows that she still has fluid
    in her ears and our regular doctor prescribes another session on the
    same antibiotic.  Six days into this medicine, we notice that the
    medicine's instructions state a different dosage !  Yipes.  We call
    the doctor for the correct dosage, is it 1cc like was originally
    prescribed or 1 tablespoon (5cc) ?  It turns out that the correct
    dosage IS 1 tablespoon. 
    
    The HMO care had 2 chances to get the dosage correct and blew it both
    times.  At least they were on the low side.   This shakes our
    confidence in the HMO.  If they botch the easy stuff, what about 
    more serious stuff.  I guess that's why we are on the HMO elect program
    and went outside the plan for the childbirth stuff. 

1 teaspoon is approx 5 cc.
1 tablespoon is 3 teaspoons or 15 cc.
I suspect you meant teaspoon, since a tablespoon is a lot to give a nipper
that age.

    Teaspoon is indeed what I meant.  I need to keep a syringe handy :)

    I've had all sorts of pharmacy screw ups, none due to the HMO doctor. 
    
    One was a simple bookeeping error.  The right medication, correct
    dosage, etc, wrong patient name on the bottle.  I briefly had visions
    of the DEA coming after me.
    
    The other could have been much more dangerous.  Correct medication,
    correct patient name, but the dosage was horribly wrong on the high
    side.  Fortunately, I had taken the medication previously and knew what
    the correct dosage should have been.
    
    Bob

    I've had many problems with my HMO and I don't consider myself
    a difficult person to get along with or full of negativity.
    
    - Went for that dreaded PAP smear [please be sensative here].
      Was left waiting naked from the waist down.  Waited and waited
      while I was hearing three female voices laughing and carrying
      on (coffee break?).  After 15-20 minutes of staring at the
      walls and feeling humiliated I walked out into the hallway
      with a tissue "blanket" wrapped around me and asked loudly,
      "IS ANYONE GOING TO ATTEND TO ME?".  I told the Nurse Practioner
      she should be embarassed to treat another woman like this.
    
    - Twenty three weeks pregnant and coughing with a very bad
      cold, during a coughing fit I heard a crack sound INSIDE
      my chest area followed by pain and difficultly breathing.
      We are traveling down the Maine Turnpike.  I am sitting
      as still as possible to keep the pain minimum.  Once home
      I call the HMO, explain I am having problems breathing,
      the voice on the phone asks me if I need to go to the
      emergency room?  (HELLO?)  I get to the Emergency Room
      and reject an x-ray (I'm pregnant) and I'm told I pulled
      a muscle.  Thirteen weeks later (I counted the days) the
      pain was almost gone.  I had broken a rib.
    
    - My seven year old daughter woke up with something that looked
      like hiccups.  I took her to the HMO without calling.  (SHE'S
      NOT BREATHING CORRECTLY).  I was told when I got there I should
      have called first.  It turns out she was having her first
      asthma attack.  Left in a room with her and a nebulizer, she
      takes it out of her mouth, I put it back in.  She says she 
      feels like she is going to throw up, and does.  I run for
      a nurse.  Oh, that's normal, NOBODY'S TELLING ME ANYTHING.
    
      I get the You're-The-Mother-Of-An-Asmatic lecture the peak flow
      meter and turn to my daughter to test it out.  She isn't making
      it move (no flow).  Oh, she's playing with me *WRONG*, she is
      not breathing correctly, but the nurse seems to think otherwise.
      Not knowing better, we leave.  My daughter goes downhill fast.
      My husband brings her to her old pediatric doctor who calls
      an ambulance to rush her to the hospital, she is in distress.
      I tell my husband to call the HMO for consent, they refuse.
      Meanwhile my daughter needs oxygen.  My husband drives her to
      the HMO, she's wilting.  He announces quite loudly that if
      she is not admitted in the next 5 minutes a law action will
      be taken.  She was admitted.
    
    - My son has Attention Deficit Disorder.  During the initial
      stages of diagnosising it we found two doctors quite willing
      to "throw" ritalin prescriptions at us.  We wanted someone to
      help us monitor this, we wanted interactive medical intervention.
                                      --------------------------------
      NOPE.  We go outside the HMO to get that and pay for it out of
      our pocket.  
     
      Physicals as still performed at the HMO and I get my prescriptions
      through the HMO so I only have to pay $3 for a one month supply.
      After two years on the medication I mentioned that my son has
      shown some tendencies of excessive compulsive behavior.  This
      is not abnormal in ADD kids.  The doctor replies, "If your son
      is showing excessive neatness, than he isn't ADD."  How ignorant!
      
    Am I happy with HMOs, no.  You have to be your own advocate.  The
    money I save by going to an HMO I use to supplement the medical
    expense I incur outside of the HMO.  After a TV report I saw, I'm
    wondering if I should be letting them do my PAP smear.

I have a few problem stories while under the HMO. However, they were all
doctor related, not HMO related (like most of the replies here). I could 
have (and have in the past) had these problems under any insurance program.

The beauty of the HMO is that when I am not satisfied, I request a different
doctor immediately, and report the other to the carrier. Try that with an
independent office. Same day appointments. Try that with an independent.
All testing facilities in same building. And on and on ...

I've had excellent care by physician assistants as well (in fact, I prefer them
to several of the doctors I will no longer see).

Doug.

    
    re. ::STACY

    I'm not going to defend HMOS but I am going to address your comments
    they are INSURANCE COMPANIES out to make a buck.  

    So what are doctors dealing with private insurance?  Totally altruistic
    well-meaning saints.  For traditional medical coverage performing
    unnecessary tests, prescribing more expensive alternatives, doing
    unnecessary procedures are all in the financial interests of the
    medical community.  It's anything but clear to me that too much medical
    care by the unethical is much worse than too little care by the
    unethical.  
    
    In all cases, HMO or traditional, you've got to find doctors and an
    organization that you trust will take care of you first and worry about
    their pocketbook second.                           
    
    Greg
    
    

re: .74

	You don't get it.  If I find a fee for service provider (doctor or group
of doctors) that I don't like, then I switch.  I do not advocate the type of fee
for service that you mentioned.  I have filed complaints with John Hancock about
that kind of service.  What I am complaining about is that an HMO is an
insurance company that has the administrative personel working for it that you
get your health care from.  There are no independent checks to make it work. 
Unless you fund a doctor that is willing to risk his job to be your medical
advocate, you will not get the health care you need.  If your HMO doctor does
the correct, minimal and expensive thing you need, then look for that doctor to
be GONE.

>There are no independent checks to make it work. 
>Unless you fund a doctor that is willing to risk his job to be your medical
>advocate, you will not get the health care you need.  If your HMO doctor does
>the correct, minimal and expensive thing you need, then look for that doctor to
>be GONE.

Interesting. My experience has been exactly the opposite. All the doctors
that I have complained about in my HMO are now gone. Doctors within the plan
have encouraged us to report our dislikes of any of the doctors or staff.

The good ones (and we're talking 'very good' here) are still their, minus our
favorite who started his own practice with two other doctors.

My doctor has run more tests than I thought necessary and I currently
have a referral (I didn't request it) for a specialist.

The HMO sends out questionaires to monitor healthcare delivery and results.

So, while you justly complain about two HMOs in MA, you can't speak for all
HMOs. And while there are many around the country that are less than adequate,
(the Atlanta area is one example of this) that is not to say that most, or
even a large minority, are bad.

Doug.

There are HMOs that are primarily clinics and there are HMOs that contract
out to private practices.  I'm in HCHP/HMO Elect.  When I joined, I expected
we would always go out of plan, but it turns out that we stay in plan
(at contracted private practices, not clinics) a good deal of the time.

    
>	You don't get it.
    
    Actually I think I do.
    
    
>  I do not advocate the type of fee
> for service that you mentioned.  I have filed complaints with John Hancock about
>that kind of service.  
    
    No fee for service ... no managed care ... so what do you advocate?
    
    
>     What I am complaining about is that an HMO is an
> insurance company that has the administrative personel working for it that you
> get your health care from.  There are no independent checks to make it work.
    
    And who is your advocate in the traditional system or in the system you
    prefer?  You and only you, just as with a HMO.
    
     
> Unless you fund a doctor that is willing to risk his job to be your medical
> advocate, you will not get the health care you need.  If your HMO doctor does
> the correct, minimal and expensive thing you need, then look for that doctor to
> be GONE.
    
    Strange, the doctors who've taken care of our kids are still there
    after taking precautionary x-rays even when they were pretty sure
    nothing serious was wrong, paid for 3-4 emergency room visits at
    Children's hospital, and had my 1-yr old son stay at Children's
    Hospital (not in the HMO) for 2 days as a precaution. (BTW since he
    was nursing that meant my wife also stayed at Children's for 2 days).
    
    ::STACY if you provide any summary stats that in any way back up your
    claimn I might begin to believe you but the anedotal evidence does
    nothing to pursuade me.  I can repsond with terrible stories of non-HMO
    care and wonderful stories of HMO care.  Are there bad HMOs ... no
    doubt; but I doubt the evidence exists of HMOs (overall) being much worse.  
    
    Greg
    

>Note 683.78                   Managed Care Stories                      78 of 78
>MROA::YANNEKIS                                       41 lines  21-MAR-1996 15:56
>--------------------------------------------------------------------------------
>
>>	You don't get it.
>
>    Actually I think I do.
>
>
>>  I do not advocate the type of fee
>> for service that you mentioned.  I have filed complaints with John Hancock
about
>>that kind of service.
>
>    No fee for service ... no managed care ... so what do you advocate?

YOU DO NOT GET IT!!  READ ALL THE WORDS!!  I DO NOT ADVOCATE THE TYPE OF FEE
FOR SERVICE THAT Y-O-U MENTIONED!

	I do advocate a Fee For Service medical care NOT HMO.  In FFS
medicine, the doctor does his best to make certain I am fine without paying
too much.  If I PAY for the doctor visits and medical tests that are NOT
LARGE then he isn't going to run unnecessary tests!  If he isn't overburdened
with MALPRACTICE INSURANCE then his office visits wouldn't cost much.  If the
fees are large then a medical savings account or a catastrophic insurance
policy would cover it.  That or just scrap the entire system and let me take
care of my own prescriptions and treatment options!


	In an HMO, the doctor has to balance his pay, his reviews and your
health.  His primary concern seems to be exactly what yours is, keeping the
money.  That is what INSURANCE companies are all about!

    
> YOU DO NOT GET IT!!  READ ALL THE WORDS!!  I DO NOT ADVOCATE THE TYPE OF FEE
> FOR SERVICE THAT Y-O-U MENTIONED!

    I don't particularly appreciate the yelling.  Maybe I'm not
    understanding everthing I should.  Maybe, just maybe, it's hard to tell
    what you're trying to say when it's buried in yelling and (IMO)
    preaching. IMO it takes two to comminicate poorly.
    
    
    Since I do not remember your ever describing exactly what you system
    you prefer I only can go by the inferences of your responses
    
    
> I do advocate a Fee For Service medical care NOT HMO.  In FFS
> medicine, the doctor does his best to make certain I am fine without paying
> too much.  If I PAY for the doctor visits and medical tests that are NOT
> LARGE then he isn't going to run unnecessary tests!  
    
    Well, right now with fee for service almost unilaterly you only pay a
    percentage (20%?) of the cost and insurance covers the rest basically
    no questions asked (especially compared to a HMO).  Are you talking
    about something else?  If so, it is counter the the most common FFS out
    there today in the US.  Would yo uexplicitly describe it?
    
    Under the most common FFS in the US today why would the doctor keep the
    fees down?  What's the incentive for them to keep the cost down; you'll
    go to a different doctor whose cheaper?  Big bad insurance companies
    pay the vast majority of the bills and how often to the untrained
    consumers doubt the word of the trained medical people; the incentive
    beyond doing what's best for the patient is to rack up the bills.        
                            
    Despite your YELLING AT ME there is tons of historical evidence
    showing the much higher use of questionable tests, more costly
    medicines, and extra procedures for those with FFS insurance versus
    those with no insurance or medicaid (care? ... which is for the poor) or
    HMOs.  There is economic theory to back up that finding also.  Given
    the presence of insurance and no cost consideration for the doctor the
    extra stuff is essentially a "free good" from the doctor's viewpoint; 
    free goods are almost always overused.   Where's your evidence of a
    doctor's in FFS doing what you say they should do?
    
    Greg
                                      
    

    

re: .80

	Sorry for the yelling in the last note.  I'll try to find some of the
references tonight.  The single bigest problem I encountered when I first hit
this was that the statistics were skewed or incomplete.  There are many books
on the differences between FFS and HMO type of medical care.

	Would you prefer flowers or candy with my appology.

    
    	Of course, most of the 'boxers don't know that Jim Stacy
    	is the Easter Bunny.
    
    

    I have severe asthma. I've been in HMOs and I've had doctors in
    single private practice.  I honestly prefer the latter.  My doctor
    was not rushed during appointments, spoke with me in her office
    after the exam, was up on the latest medications and advances in 
    asthma, and knew my file inside out.  She could limit the number of
    patients she carried in private practice and was in control of the
    types of testing and referrals she did.  She didn't have to justify 
    what she was doing to anyone else.  I also do not believe she 
    requested anything excessive while I was in her care.  In contrast,
    at the HMO I often feel like a cow in the slaughter pen (ie, the 
    objective is to get the largest number of us through in a day). 
    I can get an appointment quickly if I'm having trouble breathing,
    but, sometimes, I feel like my doctor hasn't read my file before she
    comes in for the exam. Everytime I'm in there I have to run through
    the litany of precriptions and dosages I take, sometimes twice
    depending on how many nurses/physicians asst/doctors I see.  You'd 
    think it would be written down in my file.  I never consult with the
    doctor afterwards - she might write a script or I may ask a question 
    or two, but that's usually done in the hallway while she is one her 
    way to another examining room.  She doesn't reasearch any asthma 
    topic unless I specifically ask about a medication she is not 
    familiar with.  Sometimes she gives referrals easily, other times 
    I have to fight for them.  Follow up visits are difficult to get 
    once the condition has been diagnosed and the medication prescribed.  
    Now, I do like my doctor at the HMO, we pretty much know each other 
    and she understands what I need.  I know how to deal with her to get
    what I need out of the HMO.  However, there is a vast difference 
    between the care I get from her and what I got from a doctor in 
    private practice. I think if you have a cronic condition, you like 
    to feel that you have a partnership with your physician to do what 
    it takes to meet your needs.  You both need to be pro-active; to read, 
    research and understand the illness and what is being done to treat it.  
    My private practice doctor and I had that partnership.  At the HMO, 
    I'm just a patient.  I honestly don't think my doctor has time for
    anything other than diagnosis and writing scripts.  And I think that's 
    one of the biggest differences.
    
    Mary-Michael

    <---  That's a long paragraph. 

It's a conspiracy by Lexus, Mercedes, and Ping dealers.

hth,

Art

    The AMA claims there is a glut of doctors such that many doctors coming
    out of school have no place to go. Yet it also seems that there aren't
    enough doctors to properly address patient needs. Seems to me that the
    solution is to reduce doctor salaries and put more of them to work
    rather than keep doctor salaries high and have un- or underemployed
    doctors. Why does the AMA seek to alter the supply/demand except to
    keep doctor salaries artificially high? Is that in our medical best
    interest?
    

>    The AMA claims there is a glut of doctors such that many doctors coming
>    out of school have no place to go.

There are plenty of places in this country that could use more doctors. 
The fact is that too damn many med school graduates feel the need to 
practice in major metroplitan areas where they can make big bucks
instead of taking on a lower paying (in $) but more rewarding (in terms
of human interest) practice in a more remote area. Then there's the issue
of all the 3rd world born doctors practicing in the US because they
came here to go to Med School and decided it was more lucrative to stay
here than it was to go back to their home where they were actually needed.

    .73
    
    I have had one or two doctors in 50 years who I wouldn't trust
    to take out a splinter.  The problem with HMO's is, if those doctors
    say there's nothing wrong with you, you often don't get a chance
    for a second opinion unless you scream until you're blue in the face.
    I am an accomplished screamer but even I have had to give up on one
    or two problems and take them to the walk in clinic and take the
    financial hit.
    
    
                                                                          
    

    
    yes, Rosemary I agree. you are an accomplished screamer. hth nnttm, kfc

    
    	Hmmm, makes me wonder how you'd know that.
    

    You two wise guys!  You haven't heard me even raise my voice let alone
    scream.
    
    
    

    
    	this troubles me.
    

    Chuckle chuckle chuckle  ;^)

re: .78   ::YANNEKIS


	I couldn't find the specific article I was looking for.  The house is
much cleaner now though.  I believe the Dec 21 1995 New Englang Journal of
Medicine and a Jan 96 issue of JAMA have articles on the statistical care of
HMO's versus FFS care.  However, this is where the article I was looking for
would be usefull.  As I remember, the article pointed out that data on
care was gathered into the national database from the Insurance claim forms.
Since the HMO's do not do the same paperwork as the FFS, the HMO data is
relatively absent from the database and makes it difficult to do a direct
comparison.  As I remember, the article was written because of the defeat
of legislation that funded the national database and required the HMO's to
provide inputs into the database.  I will post 2 other articles I did find
in notes after this.

This partially reproduced survey is done without permission.  It is the property
of WCVB-TV, The Boston Herald and The University of New Hampshire Survey.


This survey was administered October 23-29, 1995 and includes complete responses
from 200 physicians. The margin of error is +/-6.9% The two sub-samples of
Primary Care Physicians and Medical Specialists have a margin of error of +/-9.8%



 This is selected data from a poll of 200 Massachusetts Primary Care Physicians
and Specialists.

Abbreviations used:
PCP-Primary Care Physicians
FFS-Fee for Service Insurance
HMO-Health Maintenance Organization
PPO-Preferred Provider Organization

Why did you first decide to join an HMO Network (Among those who Participate
Only)

PCPs PCPs Specialists Specialists HMO PPO HMO PPO
                         PCP  Specialists  HMO   PPO
Ensure Income            17%  11%  	   12%   11%
More Attractive Pay       1%   0%           4%    2%
Ensure Patients          15%  30%          21%   18%
Better Care		  4%   7%           1%    4%
Prefer Working Conditions 1%   0%           0%    0%
Prefer Life-style         1%   0%           1%    0%
Just Another Way to
Get Insured Patients	 41%  36%          38%   40%
Other                    20%  16%          23%   25%

Would you say your income has increased, decreased, or remained the same since
you joined a managed care program? (Among those who participate only.)

			PCPs	Specialists
Increase		37% 	20%
Same			35%	46%
Decrease		14%	14%
Unsure			14% 	20%

Would you say your working hours have increased, decreased, or remained the
same since you joined a managed care program? (Among those who participate
only.)

			PCPs	Specialists
Increase 		39%	39%
Same			43%	45%
Decrease		 8% 	 4%
Unsure			10%     12%

Would you say the amount of paper work you have do do has increased,
decreased, or remained the same since you joined a managed care program?
(Among those who participate only.)

			PCPs	Specialists
Increase 		73%	64%
Same			14%	20%
Decrease		 5%	 4%
Unsure			 8%	12%

Please tell me whether you are very satisfied, somewhat satisfied, somewhat
dissatisfied, or very dissatisfied with your participation in managed care plans?

				PCPs	Specialists
Very Satisfied			 8%	 7%
Somewhat Satisfied		44%	42%
Somewhat Dissatisfied		31%	30%
Very Dissatisfied 		11%	16%
No Opinion 			 6%	 5%

How would you rate the care you are able to provide patients who belong to a
managed care plan compared to the care you are able to provide patients in a
traditional fee-for-service health insurance plan?

			PCPs	Specialists
Much Better		 4%	 1%
Somewhat Better 	17%	 7%
Same			57%	46%
Somewhat Worse		16%	28%
Much Worse		 2%	 8%
Unsure			 4%	10%

Have you ever felt pressure by the Administrator of Managed Care Plans
because: (Among PCP's.)

								Yes	No
Working too Slowly 						17%	83%
Ordering too many Lab/Diagnostic Tests				26%	74%
Referring too Many Patients to Specialists			21%	79%
Releasing Patients from Hospital Too Soon			48%	52%
To Provide Care to Patient Rather than send to Specialist 	16%	84%

Have you ever felt pressure by the Administrator of Managed Care Plans
because: (Among Specialists.)

							Yes 	No
Working too Slowly					26%	74%
Ordering too many Lab/Diagnostic Tests 			31%	69%
Referring too Many Patients to Specialists		12%	88%
Releasing Patients from Hospital Too Soon		39%	61%

In HMO Plans, Business People decide your Health Care, Not Doctors
(Compared by Participation in HMO Network)

                PCPs Specialists
Agree           46%     39%
Disagree        27%     55%
No Opinion      27%      6%

In FFS Plans, Business People decide your Health Care, Not Doctors (Compared
by Participation in HMO Network)

                PCPs Specialists
Agree           41%     17%
Disagree        36%     81%
No Opinion      23%      2%

HMO Plans Provide High Quality Care to Patients (Compared by Participation
in HMO Network)

                PCPs Specialists
Agree           41%     67%
Disagree        32%     14%
No Opinion      27%     19%

FFS Plans Provide High Quality Care to Patients (Compared by Participation in
HMO Network)

                PCPs Specialists
Agree		55%	76%
Disagree	14%	 9%
No Opinion	31%	15%

HMO Plans Prevent Doctors from Providing Needed Care in Order to Save Costs
(Compared by Participation in HMO Network)

                PCPs Specialists
Agree		46%	31%
Disagree	18%	62%
No Opinion	36%	7%

FFS Plans Prevent Doctors from Providing Needed Care in Order to Save Costs
(Compared by Participation in HMO Network)

                PCPs Specialists
Agree		14%	13%
Disagree	59%	78%
No Opinion	27%	 9%


If you personally were given a choice between joining an HMO or joining a
traditional fee-for-service health insurance plan, which would you prefer?

		PCPs Specialists
HMO		25% 	 8%
FFS		58%	79%
No Preference	17%	13%











Produced by WebMate  from The People who Know the Internet

According to an article in the July 11, 1995 issue of the St. Louis
Post-Dispatch, you
get what you pay for in health care.

	A recent study commissioned by the Robert Wood Johnson Foundation
found that, in general, managed care members are: three times more likely to
believe that the level of care received was wrong or inappropriate; four times
more likely to think a physical examination was not thorough; two-and-a-half
times more likely to believe their doctor didn't spend enough time with them;
and, twice as likely to feel their doctor didn't care about the situation.

	The study also said that patients waited longer to get an appointment
with the doctor and also the waiting time to actually see the doctor was
longer.

	Preventive care, which is supposed to be managed care's forte, was
mediocre according to the report. The study showed: both fee-for-service and
managed care plans had an equally high percentage of patients who did not have
a physical exam last year; women were just as unlikely to get breast exams,
pelvic exams, and Pap smears on managed care plans as they were if insured by
fee-for-service plans; managed care plans scored worse at getting women to
have mammograms.

	This study shows that consumers should weigh the advantages and
disadvantages of a health plan before signing up, said Robert Blendon,
chairman of the Harvard School of Public Health's policy management
department.

    Ya'll have to remember that not all HMOs are created equally.
    
    MadMike, glad you've had good luck with the K HMO; personally, I
    wouldn't take my dogs to them.
    
    I watched a co-worker (member of the K HMO) fight a losing battle
    with a severe URI for over two weeks.  Since I knew she belonged to
    an HMO I couldn't understand why she hadn't been in for treatment
    (I thought she hadn't called).  She said she HAD been calling for
    2 weeks but could never get past the nurse/call screener.  The
    so-called nurse keep recommending over-the-counter meds that weren't
    helping.
    
    Growing up in a coal mining region I was all too familiar with URIs
    and bronchitis.  I told the co-worker she was well beyond the "bad
    cold" stage; I could hear the sound of her trying to breathe in my
    cube across the aisle.  Although I am not a doctor and have never
    played one on TV I DO KNOW bronchitis when I hear it.  She sounded
    so bad I feared she was headed for pneumonia.
    
    I told her to dial the HMO.  I got on the line and said I was
    Charlotte's mama and if they didn't agree to see her ASAP there would
    be hell to pay.  I was told to bring her right in.  The gal was so
    weak it took myself and another co-worker just to get her to the car.
    We both rode with her to the HMO.  When we got there, Nurse Ratchett
    wanted to know which one of us was "Charlotte's mama".  Since 
    both my co-workers are ladies of color you should have seen the nurse's
    face when I said "I am, for today".
    
    They examined her immediately; my fears were well-grounded, she had
    pneumonia!!  She spent 10 days in the hospital and another 2 weeks
    recovering at home.  Charlotte's had recurring UR problems, but at
    least they've flagged her records so that she's never has had to wait
    again for an appointment since.
    
    I'm in an HMO elect now; I see my long-time physician for most stuff
    because his prices are still reasonable.  For the few prescriptions
    I must take daily that are very pricey I deal with the PCP.  Also,
    the neurosurgeon who performed the distechtomy and fusion on my neck
    is a referral specialist, I know if that causes problems I shouldn't
    have a problem getting a referral to him (at least thru October 1st).
    
    My personal take on the HMOs is that they wouldn't mind it at all
    if those of us who are not absolutely destitute continue to go to our
    long-time physicians.  My doctor of 25+ years is semi-retired; I'll
    use him as as long as I can.  If he tells me I'm REALLY sick I'll
    contact the PCP if hospitalization seems to loom ahead.