I'm Canadian, so we don't (*yet*, give Stephen Harper a chance!) have anything resembling HMOs. All I know of them is what I've seen in movies like this one or As Good As It Gets.
Are they really that bad - so impersonal and uncaring and refusing needed treatments?
h.
Yes they are. Where my husband works if we want to go to the walk in clinic it has to be preapproved by our PCP-primary care physician. If we just go to the walk in or anywhere else that is in the same area it will not be covered. My daughter came down with a nasty skin disease and it had to be approved to take her to the dermatologist to be paid. Horrible.
WWDSD?
What Would Dwight Schrute Do?
Yes they really are that bad. A few years ago my friend's dad was diagnosed with hemoroids by his doctor. Short while later we found out that he was mis-diagnosed, he had colon cancer. His HMO prevented him from suing the doctor. If the doctor hadn't have missed it when he did, his chances would have been much better. But the fact remains that it was missed, nothing could be done about it, and now he's gone. He was only 47.
So yes, in answer to the original question, HMO's are pure evil.
*There's a difference between women and girls, and it's not age*
They're that bad - and worse. Met an elderly lady in the clinic the other day. She'd had extreme back pain for more than 2 years, and had been coming to the doctor often throughout that time. Did x-rays, MRIs, etc. Finally, the week before I spoke to her she'd paid on her own to go elsewhere and they found a fractured vertebrea (spelling?).
They're bad at giving you the run-around. I went to (no joke) 13 doctors over the span of about 18 months with persistant abdominal pain, occasionally very severe. I managed to look in my file one day when I was supposed to carry it from one doc to the next and saw repeated remarks of things like, "she's imagining it" and "doing this to get attention". One doc ran tests, and called me back into the office for the results, said everything was fine. The next week one of his nurses called me to schedule surgery because the tests showed up "pre-cancerous". Got that taken care of with a different doc, still had extreme pain after a few months. Got switched AGAIN (this time the doc I was seeing moved out of state), the first time I saw him, he said "this sounds like endometriosis". Scheduled exploratory surgery for the next week, confirmed the diagnosis. Two months later I had a complete hysterectomy because it had done major damage over all that time. I was 24.
Needless to say, I DISPISE HMOs!
My heart goes out for you. Truly and sincerely, I am so sad for you. I couldn't imagine facing that at such a young age.
*There's a difference between women and girls, and it's not age*
Geez, that's terrible! I knew there was a reason that Tommy Douglas was one of my heros - other than the fact that I'm a socialist! ;)
h.
This is my *boomstick*!
Well, you have the keep in mind that HMO's are based upon the Socialist model of healthcare. Even though now the liberal Democrats in Congress regularly bash HMO's, it was years ago that these same critics were once touting HMO's as the wave of the future for healthcare.
I used to be involved in the healthcare industry and tried to veer people away from the concept of HMO's even back in those days because of the obvious deficiences.
As for the quality of care of HMO's, while I agree it's not as good as going through a non-HMO private system like Blue Cross, you're not getting much better. I have collected many, many stories over the years and my experience is that HMO quality is slightly worse than the alternative system. In many cases it comes down to the quality of the doctors. And, a great many doctors join HMO's because of the immense cost of malpractice insurance. The Trial Lawyers make their income from suing doctors at the drop of a hat. The U.S. needs some type malpractice insurance reform so the cost of healthcare can come down.
Additionally, the sheer mass of illegal aliens that have come across the border and seek free healthcare in U.S. hospitals has caused many hospitals to close their emergency rooms and strained the medicare system as a whole. Canada has fewer people to cover and has a healthier population based on the fact that Canada is not overwhelmed by illegal immigrants from Third World countries where people are generally far less healthy. Also, far too many people in Canada are on waiting lists for critical health issues and some die waiting for treatment while others simply fly to the U.S. and pay out of their own pockets to get immediate care.
I have a doctor friend who works for an HMO and he related to me that the administrators of the HMO are always pushing the doctors to spend less time with a patient and order as few tests as possible. In fact, the more patients he sees and the fewer tests performed means he gets a pay bonus if he reaches certain benchmarks. That means, the HMO's give financial incentives to doctors who give less quality healthcare. That's a formula for disaster.
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America put the "fun" back into "Fundamentalism".
While I agree with much of your post, I have to say that "Trial Lawyers" do not sue doctors at a drop of a hat. In fact, medical malpractice cases are so hard to win, that many ppl that have been wronged have no recourse. It costs thousand of dollars to try a medical malpractice case (they almost never settle). It usually takes many years to get to trial and at trial it becomes a match of experts vs experts. So, someone who had a procedure which resulted in pain and discomfort for several months and another trip to another doctor to remedy the problem could possibly receive nothing or close to nothing for her pain and suffering. Now, I am not saying that mistakes don't happen, but mistakes without consequences is a "formula for disaster."
shareThe only thing I can add is that you have to consider the immense cost of malpractice insurance. There's a reason why it's so high. I've read a number of articles about how doctors have had to either join an HMO or go out of business simply because they could not afford the malpractice insurance. This cost helps to increase healthcare costs and ends up hurting patients. Some type of reform needs to be implemented in order to fix the system.
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America put the "fun" back into "Fundamentalism".
I concur. I only hope that something is done about it sooner rather than later.
shareThe system will never be fixed until the people who administrate it are also subject to it. In the US that means our Senators and Congressmen who, once elected, currently have complete coverage for free for life.
This goes equally for Social Security.
Obviously, I don't expect to see anything properly fixed in my lifetime — or my grandchildren's lifetime.
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Sic transit gloria mundi, sometimes Tuesday is worse.
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<<Canada has fewer people to cover and has a healthier population based on the fact that Canada is not overwhelmed by illegal immigrants from Third World countries where people are generally far less healthy. Also, far too many people in Canada are on waiting lists for critical health issues and some die waiting for treatment while others simply fly to the U.S. and pay out of their own pockets to get immediate care.>>
Wow, you sound like a republican speech writer. I'm going to have to disagree with everything you've said. Yes, we have a smaller population, but not because of illegal immigration. We have our fair share of illegal immigrants as well, but they get treated at hospitals the same as citizens and landed immigrants. We don't discriminate. If you're sick and in need, you get help. That's just the way we think.
We are a healthier country than the US - but we have universal health care. Don't you see the connection?
People dying in Canada while waiting for treatment doesn't happen. If you need treatment, you get it right away. There's kind of a triage system in place. People have died while waiting for transplants, but that's because of organ shortages, not waiting lists for the actual surgery. And the same thing happens in every country around the world.
As far Canadians going south to get treatment, yes, that happens. And, for the most part, it's done by the rich and powerful who can afford it and simply don't have the patience to wait their turn. Most Canadians tend to look down on people who do that. We see it almost like line jumping at the theatre.
So yes, wait times are longer than in the US - but a homeless person can get the exact same treatment as anyone else in the country. And isn't that a positive thing? Could that be why we're a healthier country?
h.
This is my *boomstick*!
Great post hbailie!
shareYes they are depending on who your insurance company is. Cigna is "the" insurance company if you work at Verizon Wireless and it's worthless. Right now they do not want to pay for a year's worth of doctor visits and my trip to the ER when I was having heart palpitations. Not only that our local public general hospital was ready to just put the magnet on my Dad's pacemaker instead of treating him. That wasn't the ER doc, it was his doctor of 15 years and the heart specialist that was treating him.
Some people do have good insurance but most of us can't afford it . . . really. It's unfortunate when it happens to someone else. It's frustrating when it happens within your family. It's amazing and unreal when it happens to you personally.
Nancy*
Living my life vicariously through cinema
http://www.myspace.com/thejudasgoat
What's their excuse Nancy? How can they not pay when you have coverage?
I just watched an Oprah re-run of Michael Moore debating a health insurance industry spokeswoman/lobbyist, and it was great. They were talking about wait times, how in other countries they wait longer for care. Yeah, they wait longer to have a mole removed so someone can have open heart surgery. That's completely logical. Moore also made the point that, sure, our wait times are shorter. One big reason is that we've removed 50 million people (that's the # of uninsured in this country, although I think it's much higher) from the line. If you take a bunch of people out of the line, of course the line's going to get shorter.
It's funny. It's seems that the majority of Americans are for national health insurance, yet nothing ever gets done. Those insurance folks have a POWERFUL lobby.
Pretty accurate words, Bigredhunk. This is an interesting thread, especially given it's age, and the current debate going on in the US, and how nothing has changed since 2006.
If the playground rules aren't in effect then this is anarchy!
Ive been insured on HMO's and PPO's most of my life and honestly the only difference ive seen was the refferal system, currently I have had chronic back pain and it was more on my side with the hmo to make sure the tests ordered by the ortho specialist was covered (apparently ANYTHING ordered by a specialist is covered per the contract between the HMO and specialist). I then got a male pain and got refered to a urologist (here comes my view why healthcare is so high) I get told i have to get a Urinalysis and Urine Culture, before i can even make a appointment! the turn around time is less than 24 hrs for the tests here, i then get the results and make the appointment, i get there and they want to do a UA there! I refused, told the Medical assistant it wasnt needed as it was already done once and i wasnt there for a kidney or urine issue. EVERY time i had to come back for the "guess work" they wanted a UA a waste of money. then they wanted to keep "trying" things and tell me to come back in 3 months, meanwhile im on strong narcotic pain meds and still have to work drive etc. all this and it hurts like hell to walk.... Everything they did/tried my PCP could have tried at LESS cost to me and the insurance company. I got ahold of the HMO told them how i was being treated by the urology office and how i was being treated badly simply because i didnt allow them to waste money like the UA , the insurance company kicked the urology office ass, hehe Im scheduled for surgery Monday Nov 16th 09 to correct a problem, they should have just scheduled it months ago.... this was the fault of a specialty practice trying to milk the insurance money.
Another time the HMO HELPED me was at the start of the "male pain" the PCP ordered a ultrasound of the area, the radiology dept scheduled it with a female (though females are competent and usually smarter i only allow males in the area) I politely asked for a male tech, they faught me for hours, told me they didnt have a male tech on the payroll and kept trying to degrade me and ask why im discriminate towards competent females, i told them if females get female care if they want so should men. they then refused to do the test. I called the HMO and was expecting the same lecture, a female answered i explained that the radiology dept refused care, i explained what test it was and that i could not allow a female in the area, (at this point i was ready to get my head ripped off) she said that it was my right to choose to have a male tech on a rather obvious male test. I was shocked she told me she would take care of it and get a male tech for me. within 1 hour i had an appointment with a male tech at the same radiology dept that told me they didnt have male techs.
In my experiences it is the doctors being wasteful and the HMO is doing there job at TRYING to keep costs down. Hell put me to work at the HMO ill kick the doctors ass for not providing quality care, but at the same time kick his ass for wasting money like the "required" UA at EVERY VISIT even for non-urine issues... argh
HMO plans, like most other health insurance in the US, are administered by gigantic insurance corporations whose first and foremost priority is to their stockholders and to those stockholders' dividends. Generally, this means that they want to collect as much money as possible in premiums and pay out as little money as possible in coverage. The difference between what they collect and what they pay goes toward
• Stockholder dividends
• Executive compensation packages (plus "bonuses" for keeping costs down)
• Platoons (nay, regiments) of attorneys to make sure that their policyholders have as little recourse as possible. ("What the large print giveth the small print taketh away.")
All of these plans
• Private health insurance
• Medicare (federal plan) for the elderly and the disabled
• Medic-aid (state plan) for the poor
are written by lawyers — or by ex-lawyers elected to public office — and administered by accountants telling your doctor what ailments he/she can treat.
I've heard a number of scary rumors about the health care legislation that was working its way through Congress a while ago — and some even scarier rumors about the one President Obama recently signed. However, no one I am able to reach will answer any specific questions about either plan.
If I thought I could stand your northern winters at my age I'd consider emmigrating.
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Sic transit gloria mundi, sometimes Tuesday is worse.
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update, had surgery nothing has helped. Now I cant work, can barely walk without extensive medications ...... Nice Doctors Bleeding Insurance Companies, Curing patients doesnt make a doctor money.... the come back for more meds and general exams, makes the doctors money !
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