How Good is YOUR HMO?

HMO's -- Good health care for people with disabilities? Or, a dangerous jungle of peril? Some folks swear by them. Some swear at them. What do you say?

Be careful

I have a friend with pretty severe cerebral palsy. He is wheelchair bound and needs lots of assistance with eating and daily care. Because of his disability his verbal communication is slow and deliberate which tends to make people think he is less inteligent than he is. He is very inteligent and edits a local newsletter as well as correponds on the internet with people around the world. He has been living independently for over 20 years with the assistance of his friend who has a less sever case of cerebral palsy, he is presently 45.

Four weeks ago he developed tingling in his leg and went to the emergency room. A vascular study done with ultrasound determined there were no circulatory problems and he was referred to his primary care physician. A couple of days latter the tingling had spread to his other extremities and he began to lose strength in them.

His primary care physician refered him to a neurologist and ordered a CT scan of the head and an EEG. The neurologist would not see him until September (in 3 1/2 months). My friend was on Medi-Cal (a California phenomena). His PCP indicated he should be eligibal for Medi-Care because of his disability. This would enable him to be seen sooner. He inquired with the Social Security Administration and was told he was not eligible for Medi-Care. The neurologists office was contacted and informed about his daily regression. He could not be seen until September unless someone cancelled.

After having his tests completed he returned to his PCP. By now he had lost his ability to bear any weight on his legs or use his computer and was having bowel and bladder changes. His PCP ordered a cervical spine x-ray and suggested going to the emergency room at the local medical center where the neurologists are on call. This was also suggested by the radiologist examining the x-rays and an orthopaedic surgeon on call at the community hospital where the x-rays were taken.

We followed this advice and picked up the CT scan and x-rays and brought them to the emergency room of the local medical center. My friend was seen by the ER physician who immediatly consulted with the neurologist on call. They agreed that he needed to be admitted. That was 1 week ago, today my friend had surgery on his neck at the C-3 level to decompress his spinal cord and stabilize it using metal plates. The neurosugeon was very optimistic about him having function return to his extremities. If he had waited until September, this may not have been so.

The moral of the story is, if you have a condition that is going from bad to worse and you are having trouble bucking the system, go to your local medical center where specialists are on call. When you have taken care of your problem try to change the system. I will call the neurologist (the one who would not see him) on Monday and raise a little hell.

Curtis Essen Arroyo Grande CA

Live with it

We read the take on hmo's, but what does one with a disability and on income that is 1/4 the monthly income before. ANSWER: GET AN HMO THAT WILL BE YOUR BEST FRIEND. I'M NOT SAYING LOVE IT, BUT LIVE WITH IT. HANDLE IT.

IDID

I have never had a problem with my HMO here in AZ.... they always have been very good doctors that I was referred to and very accommodating.

When I need pain meds I have never been denied them. I suffer from Post Polio and degenerative rheumatoid arthritis. Since I have a fused knee and have been overdosed so to speak on may a steriod, I have to take care of myself in a preventive type way and my doctors are and always have been very assistive. I have had the gamit of orthos here in the valley and they get to know me for what I am, for I never let up on what I do how I do it and how I will always be an advocate for my disability. In fact initiated a program for disability awareness and will now develop a training unit to make staff sensitive to disabled patrons in all venues.

My body was probably not up to managing another season of football stadium patrons so we decided training all staff for this would be the next step. I love my job. I sometimes cannot work all day but I sure am zealous to the point where I do my job the best I can until my body gives me signs of slow down. I have problems with soft tissue injuries and healing for me is a long time when even my body has a strain or a sprain.

I am very happy with my insurance though, my doctors assisting me is why I am able to do what I do in a still upright position. I know a chair is in the horizon, but I will try everything until that comes to that.

Squeaking wheel

Having been a member of a HMO, Maxicare, for over 13 years, I can attest to the fact that the squeaking wheel gets the oil or "if you want good care you have to know how to play the system.

I am a post-polio quad maintaining a full time practice as an Enrolled Agent which means 16 hours per day, 7 days a week for 4 months and 40 hour weeks the rest of the year.

When I feel that a medical problem that I have is not getting proper attention I go to the medical director of the group in I am enrolled and let him know my concerns.

In this way I have received referrals to excellent outside specialists and feel that I am getting top-notch care.

Jerry Stein

Most people are not aware that when they sign the contract with the health insurance company, they are signing that they waive away their right to sue that company....check your policy! Most people (that I've questioned), are not aware that in most HMOs the M.D. is given a bonus for not prescribing high-dollar antibiotics, and are also given a bonus for not discussing (telling a patient) about their true condition if it is going to involve high-dollar treatment. I've asked M.D.s about this, and they admit it's true.

I am a registered nurse, and I can tell you that if you try to treat some types of infection with a low-cost antibiotic, (erythromycin as an example) when you really need something like Ceclor...which costs more, you may as well drink water for all the good it will do you. There is a number you can call to complain about HMOs, but be aware that are overwhelmed.

According to an article I read in one of my journals, they are not truely capable of handling the responses they are getting. Also, if you work for the U.S. government, they cannot help you, and no one seems to be able to tell me who can....I'm still doing research on that one. The number for The Department of Corporations is 1 (800) 400-0815

I feel the way to handle this is to do it yourself. Get mad....make calls....and complain! Don't let them put you off, get copies of ALL your records...then request copies of every visit thereafter. Let the insurance company know that you are not going to take some mealy-mouthed answers, and you are going to let everyone know how you are treated. We hear horror stories, and we can't believe it will happen to us...trust me...it's only a matter of time before you are the one telling the stories. Do something now...write letters...talk to people waiting in line at the bank or store...spread the news. You are not alone in this, and if enough of us take a stand we can do something. Feel free to write me with any ideas, and also with anything that you have found out....let's put it all together. Last but definately not least...a personal thank you to the webmaster of this site. Keep up the good work!

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We need a law

A law should be passed where physician must be paid a set fee, and not by how much money they save the HMO. I am with Kaiser and not once, in 13 years, has my primary physician recommended a complete physical.

Another problem with the system is when doctors operate their own practice during the week and work part time at an HMO on the weekend.

William Lineberger
lineberg@ix.netcom.com

We need control

I have had reasonably good luck with my HMO for basic whitebread health care, i.e., bronchitis, indigestion, etc. When it comes to dealing with "scary" stuff, like chronic pain, ongoing physical therapy, and diagnosis of sci related symptoms, far too much depends on the personal biases and philosophy of the primary care physician.

I am a professional, employed full-time in my field, and do not wish to go on full, or even partial disability leave from my career. At the same time, I am a wheelchair user who deals daily with severe pain and the various the effects of sci and arthritis (and middle age, and bad hair). Because I insist on continuing to be professionally and socially active outside the home, my doctors are opposed to prescribing effective pain medication (anything stronger than ibuprophin).

When I request review by a specialist, they tend to select other doctors that share their bias against analgesics. (I was told by one, "If you can sit here and discuss the issue with me, you don't need it, yet.")

I cannot afford to change to a more expensive health care plan that give me more control. I have been on this carousel for over twelve years, and the HMO system makes it difficult to get second opinions from physicians unconnected with the primary care physician. When, due to bias, or lack of knowledge, or state- or lawsuit-induced fear, our doctors won't go to bat for us, how can we work within the HMO system to shop for doctors that will?

K.Hetrick
Dearborn Heights, MI

Not for us

HMO's are not for people with disabilities. In fact, they are not for sick people either. They are in the business of making money only and that means selling insurance to healthy, young people only. God help them if they get sick or disabled, because the HMO won't!

Judy Manteuffel
judyma@shivasys.org

What's your take on this?