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Health Maintenance Organizations

Health Maintenance Organizations Throughout history, America has always strived for freedom and quality of life. Wars were fought and people died to preserve these possessions. We are now in a time where we may see these ideals crumble like dust in the wind. Health Maintenance Organizations, HMOs are currently depriving millions of people from quality health acre and freedom of choice. This is occurring because people who are enrolled in HMOs are unable to choose the doctor that they want.

Also patients lose the quality of care because HMOs interfere with the health care providers decisions. The Health Maintenance Organization has been proven to”sometimes interfere with physicians exercise of sound medical judgement and avoid covering necessary medical care, causing members to either pay out of their own pockets or go without” (Schlossman). This means that the insurance company does not really care about you. The insurance company only cares about how much money it has to spend on you as a person and if you need a type of special care that cost money either you can pay for it your self or just go without the care that is needed. This interference often compromises the patients ability to have freedom of choice in selecting a provider and to get the best quality for their health care needs.

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This freedom of choice is the ability to choice the doctor that you want as a doctor. Yet instead HMOs pick the doctor for you. All over the United States HMOs have denied patients the medical care which they need. In Charlotte, North Carolina, for example, a boy named Ethan Bedrick was born with cerebral palsy. His doctors said that in order for him to be able to ever walk, he would need extensive therapy.

Yet according to HMO policy, patients are only allowed a maximum of fifteen therapy sessions per year; therefore, his health plan said “NO.” The HMO said no when a little boy said please help. This proves why HMOs frequently deprive patients of the optimum quality of life. This little boys future of being able to walk was crushed by an insurance company that was so money grubbing greedy that it could not stretch the rule for this case. Since the boys therapy is not being paid for the HMOs gets a bonus in their paycheck. They took the money that was supposed to go to the therapy and put it into their pockets. An epidemic has occurred in most senior citizens lives. Since January 1, 1999 440,000 senior citizens have lost their HMO privileges.

In essence, HMOs decided to arbitrarily eliminate the senior citizen plan. The sad reality is that many members who subscribed to these particular HMOs for its senior citizens package are out of luck and without medical coverage. For many people over the age of 65 who once had HMO benefits are now scrambling to find a new insurance. There are people like Allen Martin from New York, who is over the age of 65. Due to a severe disease his kidneys do not work.

As a result he needs dialysis, (which is when the waste material is flushed out of the body) three times a week. This process is extremely expensive costing hundreds of dollars each time and what was once paid for by the HMO, but now he has to find some way to pay for it on his own. In many cases doctors are unable to tell a patient the limitations of their particular HMO and how it interferes with the ability to provide good medicine. This is called the “gag rule”. These gag rules do not allow the doctors to say anything bad or against HMOs.

Also the rules restrain doctors from telling the patient certain things that HMOs do not pay for such as special procedures that might benefit the patients condition. Doctors who work with HMOs have to sign a contract. This contract states that a doctor is unable to tell patients certain things. Yet in frequent cases doctors have felt limited by their contract with HMOs. This is because they want to tell patients important facts, but are unable to because of the contract.

If the doctors break this agreement, they stand to lose their contract with the HMO. The Health Maintenance Organization created a situation where patients have lost the ability to select the doctor of their choice. In addition, many plans have something called a “Gatekeeper”. The gatekepper is a business man who probibly does not know anything abnout medicine or what to do in a critical medical situation and makes his descions soley on how much is it going to cost. The Gatekeeper tells you that you must see a Primary Physician before you can see a Specialist. This is just one extra step that the patient must take to get care. This process normally takes an extended amount of time resulting in an interference in quality of care. Freedom of choice is a fundamental aspect of being an American. This is being eliminated by HMOs whose only concern is making money.

These companies seem to have little interest in the quality of care and the health of the people of this country. Finally, the health care system in this country is being denied the opportunity to provide treatment which is based on the decisions of trained professionals, but rather is being dictated by money managers who profit from preventing care from being given. The United States has been built upon the principles of choice and quality. We must not allow these basic concepts to disappear.


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