The Healthcare Industry of America; An investigative look at HMOs Essa

The Healthcare Industry of America: An investigative look at HMO's It's no secret that Health Maintenance Organizations, known as HMO's, have made healthcare affordable for many Americans, but at what risks? Most employers offer some type of health care plan that is an HMO. Let's face it, given the choice among insurance coverage through your employer, in which he pays half the costs, or acquiring private insurance coverage outside your employer, most Americans choose to go with employer-provided HMO's. Why then, has there been so much controversy with HMO's? An HMO is an organization whereby the subscriber, or patient, is allowed to choose a medical provider from a list of doctors within a certain medical group. Each physician has signed a contract to see patients at a reduced rate. This type of plan does not allow the patient freedom to see just any doctor. All referrals to a doctor, other than the patient's primary care physician, must be approved by both that physician, and the insurance company. Most physicians add HMO's as a supplement to their practices. With HMO's, the patient has little or no co-payment depending on how the plan is set up. Most HMO co-payments range between $5 to $15 dollars per office visit. The doctor, may receive half or less than half of his normal fee from the insurance companies. HMO's are characterized with the tendency to over or under treat patients. HMO's put limitations not only on the income of the provider, but also on the type of treatment that may be done. If a patient is in need of a specialist fo r a specific ailment, the insurance company has to review and approve a referral and deem it necessary. The process involves the patient going to his or her general practitioner, also re... ...he pros. It helps immensely if you have the support of your primary care physician. If you have a hearing, find out how many people will be there and make up a folder for each one. a). Contact local lawmakers, senators, representatives. b). Contact your State Insurance Commission in writing about your complaint. Send copies of correspondence between you and your HMO. Let the HMO know you are contacting your State Insurance Commission. Works Cited Evans, M. Stanton. "If you're in an HMO, here's why." Consumers' Research Magazine, Dec. 1997 p10(6). Sherrid, Pamela. "Mismanaged Care." U.S. News & World Report, Nov. 24, 1997 p57(3). Lowenberg, Stanley C. "Hard Path to HMO reform." Los Angeles Times, Feb. 2, 1998 pB(4) col. 1. Figueroa, Liz. "State Regulations of Healthcare Reform." Los Angeles Times, March 4, 1998 pB(6) col. 4. The Healthcare Industry of America; An investigative look at HMO's Essa The Healthcare Industry of America: An investigative look at HMO's It's no secret that Health Maintenance Organizations, known as HMO's, have made healthcare affordable for many Americans, but at what risks? Most employers offer some type of health care plan that is an HMO. Let's face it, given the choice among insurance coverage through your employer, in which he pays half the costs, or acquiring private insurance coverage outside your employer, most Americans choose to go with employer-provided HMO's. Why then, has there been so much controversy with HMO's? An HMO is an organization whereby the subscriber, or patient, is allowed to choose a medical provider from a list of doctors within a certain medical group. Each physician has signed a contract to see patients at a reduced rate. This type of plan does not allow the patient freedom to see just any doctor. All referrals to a doctor, other than the patient's primary care physician, must be approved by both that physician, and the insurance company. Most physicians add HMO's as a supplement to their practices. With HMO's, the patient has little or no co-payment depending on how the plan is set up. Most HMO co-payments range between $5 to $15 dollars per office visit. The doctor, may receive half or less than half of his normal fee from the insurance companies. HMO's are characterized with the tendency to over or under treat patients. HMO's put limitations not only on the income of the provider, but also on the type of treatment that may be done. If a patient is in need of a specialist fo r a specific ailment, the insurance company has to review and approve a referral and deem it necessary. The process involves the patient going to his or her general practitioner, also re... ...he pros. It helps immensely if you have the support of your primary care physician. If you have a hearing, find out how many people will be there and make up a folder for each one. a). Contact local lawmakers, senators, representatives. b). Contact your State Insurance Commission in writing about your complaint. Send copies of correspondence between you and your HMO. Let the HMO know you are contacting your State Insurance Commission. Works Cited Evans, M. Stanton. "If you're in an HMO, here's why." Consumers' Research Magazine, Dec. 1997 p10(6). Sherrid, Pamela. "Mismanaged Care." U.S. News & World Report, Nov. 24, 1997 p57(3). Lowenberg, Stanley C. "Hard Path to HMO reform." Los Angeles Times, Feb. 2, 1998 pB(4) col. 1. Figueroa, Liz. "State Regulations of Healthcare Reform." Los Angeles Times, March 4, 1998 pB(6) col. 4.