Friday, July 24, 2009

HMO Schmo

When an HMO was first in the works for employee medical insurance at the company I worked for, I was told that it would be an over-sight group that would negotiate physician fees to keep costs reasonable for patients. I was not told that it would be a for-profit outfit that physicians would buy into. I was not told that physicians would make bonuses related to the number of patients they saw during a day. I was not told that the HMO, not the physician, would decide if a procedure or care regimen was warranted (even if the physician prescribed it). I was not told that the main thrust would be profit for the HMO.

Medical insurance started as a source of coverage for emergency treatment. Visits to the doctor to have physicals, beans removed from ears, broken bones splinted, ingrown toe-nails treated, etc., were visits for which the patient expected to pay. Then wellness care came on the horizon, and insurance companies started charging more for premiums to pay for these visits. New medical advances and cures have come into being, all raising costs for treatment. Now, insurance companies hire employees to see how they can refuse to pay claims... as in 'she has cancer, she'll die anyway, why should we pay for chemo or other treatments just to prolong her life? ' (My scenario and italics.) God forbid that the treatment might actually provide a cure.

I need to state here that, to my knowledge, my current insurance provider has refused payment for only one procedure during my current care regimen, and that was because the pre-approval period had elapsed. The approval was updated and the treatment carried through and paid.

One thing that we as patients are not told is the amount paid to physicians and test & treatment providers. I inadvertently discovered that one provider received only $5 over my co-payment for each visit. If this is typical, one way to cut health costs throughout the nation would be for patients to pay the full amount for the visit, thereby relieving doctors of the cost of dealing with insurance companies. But then, what do I know? I'm just part of the general public.

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