Are there any other disadvantages to using HMO's other than seeing your
primary doctor 1st and paying the small office fee before going to a
specialist that your primary recommends? Also, will all hospitals take
you as a patient or only in the area that you live. For example, the
next county over, I have relatives and if I would need medical attention
or surgery would prefer to be in that county's hospital, is that
possible?  I have Blue Cross & Blue Shield, but this new job offers HMO
and I could save the premium I pay now. Please don't sugar coat any good
or bad information, I can take it, thanks to all who read this post and
reply in advance.       Ed

... "I drank what!?!" * Socrates
___ Blue Wave/QWK v2.12

: Are there any other disadvantages to using HMO's other than seeing your
: primary doctor 1st and paying the small office fee before going to a
: specialist that your primary recommends? Also, will all hospitals take
: you as a patient or only in the area that you live. For example, the
: next county over, I have relatives and if I would need medical attention
: or surgery would prefer to be in that county's hospital, is that
: possible?  I have Blue Cross & Blue Shield, but this new job offers HMO
: and I could save the premium I pay now. Please don't sugar coat any good
: or bad information, I can take it, thanks to all who read this post and
: reply in advance.       Ed

HMO's control costs mainly by reducing utilization.  They save the most
money by reducing inpatient days.  This may never be a problem for you,
but they will strongly encourage early discharge from any hospital stay.
This often works out fine if patients have good support systems at home,
but patients are going home sicker than they have ever done before.  The
biggest problem for me has been with other utilization controls.  There
are several things that you should know about them:

        1) The HMO probably pays your primary care physician a capitation
rate.  This means that your doctor makes the SAME amount of money,
regardless of the services that he provides for you.  So if you never see
him, he makes a good profit, but if you are sick, he may lose money on
your care.  This creates a disincentive to treat sick people.

        2)  HMOs often create barriers of some kind to prevent you from  
getting services such as diagnostic testing or visits with specialists.  
In my HMO, I can't get lab testing in my physician's office, but have to
go across town to a specific reference lab.  And I still can't get
referrals to the only allergist in town who has ever treated my
daughter's asthma properly.  In that case, I simply pay for his visits
out-of-pocket, but if she ever ended up hospitalized under his care, the
HMO would not cover it.

        3)  If a primary care physician "bucks the system" and orders
diagnostic testing and gives referrals to specialists, he becomes a
"high-cost provider" and may be dropped from the plan.  

I wouldn't let the health care coverage determine whether I accepted a
job offer or not, but I think that you should know these things in
advance.  In fact all patients should be informed of them, up front.  
This is not the current practice.  

--
Donna Kinney                    | My views are mine, alone.  It's unlikely

I just shifted from a worthless Blue Cross Prudent Buyer plan to
the Blue Cross HMO.

Of the few feet I've read of the miles of fine print they sent,
only one section bothers me: it says that if I need to dial 911,
I shouldn't.  I should find and call the number of my regional
Blue Cross HMO, explain the problem to them, and if they decide
that 911 should be dialed, they'll do it.  If I'm holding my head
in my hand, I suspect that I'll throw caution to the wind and do
it myself.

More generally, I've heard that the worst thing about HMOs is
that they treat you like cattle.

- Larry

These physicans who are not "cost effective" will be weeded out of your
HMO.  I have sat in on meetings where just such a thing was done.  They
have no choice.  They have a fixed sum of money, so money has to be the
bottom line.

writes:

Hi,

I've heard horror stories about HMOs.  Happily, the one I belong to is
great.  Recently, (last month) I had to have surgery on my spine
(ruptured disk fragment compressing my spinal cord).  So far, I've paid
$30 ($10 to internist who noticed an abnormal reflex, $10 to the
neurologist he referred me to and $10 to the neurosurgeon who performed
the surgery).  I added up all the bills for the surgery (MRI, hospital
stay, radiologists, surgeon, etc.) and it comes to about $13,000.

When I was in the hospital (private room), the neurosurgeon actually
asked me when I wanted to go home.  He said it was up to me...if I felt
I needed more time in the hospital, then I should stay.  I left after
two days so I could get some rest.  They take your vitals every two
hours.  It was hard to get uninterrupted rest.  I walzed out of the
hospital without paying a dime.

I've noticed that my internist doesn't hesitate to order tests or
referrals if he feels it's necessary.  I don't know if the HMO is
giving him grief but they pay the bills.  I'm not a 'healthy' patient.
I have high {*filter*} pressure, a bad back and suffer from depression which
requires meds.

Anyway, these are my experiences with an HMO.  

Pat

HMOs make every effort to limit the patient to doctors and facilities
that are part of the network. By signing up for an HMO, you lose the
ability to choose the doctor and facility of your choice. HMOs accept a
flat fee, and do all of your medical care in exchange. They have a
natural incentive to cut costs and corners at your expense.

When I was diagnosed with advanced cancer more than five years ago, I
traveled across the country to get expensive (and succesful) treatments
that my fee for service insurance paid for. It is highly unlikely that an
HMO would've paid. So sometimes freedom of choice is a life or death
matter.

                       -Steve Dunn

A positive note about HMO's:

My father recently had a heart transplant.  We just received a copy of
the bill - $366,000.  The HMO he belongs to covered it without any
difficulties.  They also covered the quad bypass he had five years ago
and the intervening health care (very significant!).  Their primary
care physician is very good about referrals to the specialists my
parents use.  For chronically ill patients who's specialists accept
the HMO, I believe there is no more cost-effective way to go.
Traditional health care plans can limit the lifetime coverage amounts
- I have known people this has happened to.  Not a good thing for a
chronically ill person!

My husband and I also use an HMO (different one).  Well baby care, my
pregnancy, etc were all covered with a minimum of fuss.

Good luck!
--E.Katz