healht care

WHat would be the risks and benefits of an older person with a chronic diesease selecting a mangaged care plan?

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asked by Cyndi
  1. I had a friend (notice the past tense, there) who had several health problems; then the company he worked for contracted with a managed care system (HMO) for their employees' health care.

    He went to his primary care doctor one January because he felt awful, couldn't breathe well, etc. His doctor ran some tests and conducted an exam ... and then referred him to a heart specialist. But since the referral had to be approved by some office-folks in the HMO's office, it took 6 weeks or so to get an appointment with that specialist. Finally he saw the specialist, who ordered more tests -- and all those referrals for tests had to be approved by the HMO. It took about a month or 6 weeks for him to be able to have those tests run (one of which was an echo-cardiogram). Then it took several weeks for the specialist to call his primary doctor with the results. Someone called him and said he needed to make an appt with his primary doctor.

    By the time he saw his primary doctor again, about 4 months had passed, during which time his heart problem was getting worse.

    So he went to see his primary doctor, who ran more tests, and then referred him to a sleep-disorder specialist -- and all the referral approvals and test approvals, etc., took weeks to get done and another 4 months passed by.

    Back and forth, from one doctor to the next, always requiring approval from the HMO. To make a long story short, 14 months after that first appointment with his primary doctor, he died. He was 41 years old.

    Now can you imagine what would happen to an older person who could have health problems even worse than his?

    It's the constant approval of referrals and the "you must stay in the network" elements to HMOs that make them dangerous. People don't often get seen in a timely manner unless they are willing and able to pay the higher rates to be able to go outside the HMO's network.

    I've read about others with cancer and other types of health problems who ran into the same types of things. Some lived; others didn't.

    I also have friends who were able to go outside the network and have their health issues taken care of quickly and thoroughly -- one who was having sinus infections about every 6-8 weeks and who went outside the network to get the sinus surgery she needed; another who was experiencing extreme eye problems (which turned out to be detached retinas) and who went outside the network to select her own surgeon (she did not end up blind).

    I know this is very negative, but I avoid "managed care" (HMOs) at all costs because of many other people's bad experiences.

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