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 for 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...
... middle of paper ...
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.
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.
Need Writing Help?
Get feedback on grammar, clarity, concision and logic instantly.Check your paper »
- The Players in the Cocaine Game: An investigative look at the dealers, suppliers, and enforcers From the third world of many South American countries, to the third street projects in the inner-city, to the third floor of a downtown luxury loft, cocaine is prevalent and being used. The business of the coca leaf is a billion dollar a year industry, if not more. Our foreign counterparts are profiting in full off of the drug. Mexico, Peru, and Colombia are some of the countries in Central and South America that are profiting and manufacturing cocaine.... [tags: Essays Papers]
3328 words (9.5 pages)
- Problems with HMO's Many employees must designate a health plan through their employer. These days, as HMOs (health maintenance organizations) and managed care plans continue to proliferate, that means a choice between bad and worse. As employees line up in the lunch-room for a process called open enrollment, they may be surprised to learn that managed care rates have gone up — again. The mirage that managed care is cheaper care is finally fading. And, for the first time in years, employees may also have the promise of free choice in medicine in the form of a new method of financing health care.... [tags: Papers]
1162 words (3.3 pages)
- ... The failure of the US to recognize what a critical opportunity we have missed and the steps we need to take to adapt and reduce the consequences of our actions is one of Hertsgaard’s most prominent points, and is a large part of his unveiling of how the global warming situation was handled. The undoubted authority and urgency in Hertsgaard’s tone along with his undisputed evidence and research is what leaves readers flipping through his works, eager to listen to what he has to say and to consider the solutions he offers.... [tags: violated laws, regulations, wrongdoings]
756 words (2.2 pages)
- Introduction Criminal Investigative Analysis is an investigative tool used by law enforcement officials to help determine the unknown offender of a specific crime, usually involving violent crimes. The purpose of Criminal Investigative Analysis is to create a profile containing characteristics of the offender who committed a certain crime. Law enforcement then uses this profile to help determine a possible suspect that fits into that profile. The Criminal Investigative Analysis has been crucial in solving some very large cases, where law enforcement had no leads and used this tool to come up with a possible suspect.... [tags: Crime, Federal Bureau of Investigation, Violence]
1714 words (4.9 pages)
- Steel Industry In the early part of this century was a time when industry was booming with growth around the installation of major railroads. With this growth came the transatlantic cable, the telegraph, and a whole lot of steel. Steel would be needed in the construction of these new transportation systems and communications were now possible between businesses and industries. (Wren, 2005) This paper will first discuss the development of the steel industry. Next, it will examine steel, and in the impact it had on the transportation industry.... [tags: Industry]
1473 words (4.2 pages)
- DNA is a double helix molecule that contains information that is used to make up a person’s body. DNA controls every aspect of a person’s body from their eye and hair color, height, and other features. DNA’s specific and unique characteristic can be crucial when solving a crime. DNA can be used to convict a suspect or exonerate an innocent person. When DNA is found it is even more important that is handle properly to ensure proper identification and accuracy of testing. The evolution of DNA technology is vital to the process of solving crimes, however the process by which DNA is found and handle can jeopardize its powerfulness.... [tags: DNA Investigative Tool]
2113 words (6 pages)
- ... The decade from the mid-sixties to the mid-seventies was the end of innocence for many journalists. As many of them have recalled, reporting grew less deferential to politicians and more insistent and probing from the mid-1960s on. Journalists began to shed their almost passive demeanours and brought a real fire to the profession. One of the key reasons why investigative journalism prospered during the 1960s was because of the way newspapers became more critical of established power. From 1960 onwards news coverage grew increasingly negative.... [tags: media, press, scandal]
2448 words (7 pages)
- Investigative Reporting In the seventeenth century the puritans lived through relationships, religion, community, discipline and punishment in a way that would bring honor and glory to God. In The Scarlet Letter, the puritans of seventeenth century Boston society were a fate driven religious group that would not accept sin of any kind without punishment. The type of punishment they would use the most was that of public humiliation and to be taunted by the community around the one who committed the crime or sin.... [tags: essays research papers]
671 words (1.9 pages)
- HMO Regulation Health Maintenance Organizations, or HMO’s, are a very important part of the American health care system. Also referred to as managed care programs, HMO's are combinations of doctors and insurance companies that are formed into one organization. This organization provides treatment to its members at fixed costs and decides on what treatment, if any, will be given based on the patient's or doctor's current health plan. Sometimes, no treatment is given at all. HMO's main concerns are to control costs and supposedly provide the best possible treatment to their patients.... [tags: essays research papers]
1302 words (3.7 pages)
- HMO Regulation Health Maintenance Organizations, or HMO's, are a very important part of the American health care system. They involve elements such as beneficial health care programs like Medicare for seniors and Medicaid for the poor. HMO's are sometimes referred to as managed care programs, which involves participation through clinics, physicians and insurance companies. Other essential parts of HMO's include prescription drug plans, such as distribution and cost, and they are also important for information needed by emergency room residents in cases of emergencies.... [tags: Papers]
1421 words (4.1 pages)