HMO Problems

If you or anyone you know have had HMO problems, then you can understand how this type of medical insurance tends to send people screaming in the other direction.

It may or may not save you money, depending on the problems you come across, and the illness you're trying to get treated. Some of the problems are common and you can get around them, others can be more difficult and cost you more money and time.

For example. Someone I know had a broken jaw. She went to a doctor listed with HMO and had her jaw set and wired together. It was like this for four months. Anyone who's had their jaw wired, knows this is no picnic.

After a month, she started having problems with her jaw. It hurt all the time and from looking at her, you could see the jaw was dropping and not aligned properly.

She went back to the doctor, and was told the wire was growing into her gums, her jaw bone was not growing back together like it should, and that she would have to go through more surgery to fix the problem.

But here's the kicker, we discovered the doctor who did the original surgery, had just opened her practice, and had never performed this type of surgery before, and of course did not know how to perform the surgery needed to correct the problem.

So my friend was referred to another doctor who could do the procedure. The problem however is that he was not listed with HMO. The doctor had to go through hoops trying to get HMO to cover the procedure.

They needed proof, documentation and pictures before they would even consider approving her surgery. It took them one month to approve the corrective surgery.

In the end, it took a total of 4 months to get her jaw fixed, fifteen days from work, 25 pounds of lost weight, and more aggravation than you need to go through when you're sick.

The only thing I can fault her for is not checking out the doctor, the way we all should. Being listed with HMO doesn't mean anything, and it surely doesn't mean the doctor knows what they are doing.

So I've listed a few of the problems you could possibly run into with HMO, and how you can avoid them.

Check The List Of Doctors With Your HMO:

See if the HMO list has a decent supply of doctors in each category. Also check for the listings of medical specialists, like oncologists, cardiologists, neurologists, etc. It's better to have more than one doctor to choose from.

Choosing Your HMO Doctor:

HMO is like any other medical plan that exist today. They have a list of doctors you can choose from. Where you go wrong is choosing a doctor you know absolutely nothing about, and not scheduling an appointment with them - so you can ask questions.

Be very polite and ask them about their medical training, and if they have ever done the type of surgery you are scheduled for. If they won't or don't answer you questions, then you should find another doctor.

Even if they answer your questions, it doesn't mean you are going to like the answer. If you don't, find yourself another doctor.

HMOs may be a little reluctant in letting you change doctors, but if you insist, they will eventually agree. It is better to go through this, than using a doctor who you either don't like or can't perform the procedure you need.

Getting A Second Opinion:

Getting a second opinion can be rather tricky. Especially if you were referred to a doctor that happens to be a colleague or friend of your doctor.

If they both belong to your HMO, the second doctor may be rather hesitant to give an honest opinion, because he's afraid of offending his friend or colleague.

What you may need to do is go outside your HMO plan, and find a doctor that has no relationship with your doctor, and has nothing to gain.

You need to check with your HMO to see if they would cover a second opinion from outside the plan. If they don't, you might want to consider doing it on your own, but the money would come out of your pockets.

Will Your HMO Cover You When Traveling:

This is something you need to find out, and not assume your plan will cover you when traveling. Most HMOs won't pay for medical attention done by doctors outside the plan.

Unless it's a true emergency. Like an automobile accident, heart attack, stroke, etc. If you do a lot of traveling, you may want to consider finding out exactly what medical expenses your HMO plan covers, and take action to get extra coverage from a health insurance program.

Your HMO Doctor Does Not Care:

You may feel your HMO doctor doesn't care, that to him, you're just a number. He comes into the examining room and in 5 minutes he's gone.

The nurse takes your weight, blood pressure and writes your problem on the chart, and all you get is 5 minutes of the doctors time.

All doctors are busy, regardless of which medical plan they are listed with. It's your responsibility to speak up and ask questions about your condition, the medication that is prescribed, the side effects, or whatever else is on your mind about your medical condition.

If you feel the doctor should take your blood pressure, then tell them. It's not so much about being an HMO doctor, than it is about you speaking up and letting them know what you want.

Your HMOs Reputation:

Depending on your employer, you may have a choice, and then you may not have a choice, about which insurance plan you go with. Normally companies have at least two or three insurance plans their employees can choose from.

If you have that choice, before signing up with an HMO, investigate them by contacting either the department of corporations or the department of insurance, or whatever agency oversees HMO where you live.

They can let you know the reputation of the HMO you are considering. If they have good record, and this is what you want, then go with them. On the other hand, if they have a history of consumer complaints against them, you might want to consider going with another plan.

Will Your HMO Pay For Unusual Or Experimental Care:

This is something you should find out before you even sign with the HMO. You may not need unusual or experimental care at this time in your life, but you never know what may happen in the future.

Most HMOs will not cover this type of medical care. For example, bone marrow transplants or heart and lung transplants. Neither will they pay for experimental procedures or drugs. All of this is something you want to consider before going with an HMO.

You get the picture about HMO problems. They have been around long enough for people to have heard a lot of horror stories. Even with the stories, people are still signing up with them.

This is because, if handled correctly, HMOs came save you money in the long run. The problems start when we as patients, assume certain things about the doctors, the care, the coverage and the payments.

If this is your choice of medical coverage, then please investigate all avenues of your plan. Don't wait for an emergency to happen before you discover the treatment that could save your life is not covered, and will not be paid.