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1996-01-01
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MCL Extra
How to Choose an HMO
This is the final installment in the NewsCenter
5 series on HMOs. The entire series, including
the patient and physician polls in HTM format,
are contained in the file MCNC5.*, which may be
freq'd from 1:275/14; and other Fidnoet BBSs
that carry the ABLEFiles Distribution Network
(AFDN), and ftp'd from ftp.icdi.wvu.edu on the
Internet. Please allow at least one week for
processing.]
Throughout this week we've brought you a series of special reports
on managed care with the release of an exclusive Newscenter
Five/Boston Herald poll of doctors and patients.
Tonight on the HealthBeat, some important advice on how to choose
the best health plan for you and your family.
Carol Sullivan was vomiting uncontrollably. After three days without
any improvement, Carol headed straight for the emergency room.
Carol Sullivan:
"From prior, past experiences with my doctor I knew he wouldn't
do anything except take fluids and tell me to go home."
Carol's diagnosis - food poisoning and severe dehydration. Add to
that a headache when the 849 dollar bill arrived.
It's a costly ER visit that could have been avoided if Carol had a
primary care physician she trusted.
And that is KEY when choosing a health plan - finding a doctor you
trust. . . .
Bob Hughes (Mass. Assoc. of HMOs):
"The large networks have thousands of doctors in them and that's
usually the basis along which most people make a selection,
cause their doctor does business with their plan."
You also must assess your needs.
* Do you require a specialist?
* Is that doctor part of the plan?
* What hospitals can you visit?
* And make sure you know what services are covered.
* Do you wear eyeglasses?
* Do you need prescriptions frequently or access to mental health care.
Dr. Harry Greene (Mass Medical Society):
"If you have a pre-existing condition, how does this new plan
cover that? If you have heart disease for example, will you be
excluded from coverage for that if you take on a new plan?"
When considering cost:
* write down how much, if any, your company requires you contribute
* what the co-payments or deductibles are
* and whether there is a limit to what your insurance company will pay.
Choosing a health plan can be overwhelming. But experts say - take
heart. . . .
Dr Harry Greene:
"The HMO industry is improving, they want to do a good job -
let's be honest. I think one of the ways is to try to put out
more information so people understand their plan better because
its not to their benefit to have people not understand and call
in sick or distressed to find out the plan doesn't work for
them."
Finally, before you enroll in a health plan - make sure you know how
it works.
* What do you do in case of an emergency
* will you have access to only certain pharmacies or specialists.
* and what paperwork will you have to fill out each time you need care.
As you've heard there is a lot of homework to be done...but it's
your health - and nothing could be more important.
Moderator's Memo:
And the most important advice of all about choosing
an HMO: Don't, if there is an alternative.
[This report from medical reporter Heather Kahn aired 16-Nov-1995.]
...For further information, contact CURE, 812 Stephen St., Berkeley
Springs, WV 25411. 304-258-LIFE/258-5433 (CUREltd@ix.netcom.com)