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  • 5 years later...

Q. What does HMO stand for?A. This is actually a variation of the phrase, "HEY MOE." Its roots go back to a concept pioneered by Moe of the Three Stooges, who discovered that a patient could be made to forget about the pain in his foot if he was poked hard enough in the eyes.Q. I just joined an HMO. How difficult will it be to choose the doctor I want?A. Just slightly more difficult than choosing your parents. Your insurer will provide you with a book listing all the doctors in the plan. These doctors basically fall into two categories - those who are no longer accepting new patients, and those who will see you but are no longer participating in the plan.

But don't worry; the remaining doctor who is still in the plan and accepting new patients has an office just a half day's drive away, and a diploma from a Third World country.Q. Do all diagnostic procedures require pre-certification?A. No. Only those you need.Q. Can I get coverage for my preexisting conditions?A. Certainly, as long as they don't require any treatment.Q. What happens if I want to try alternative forms of medicine?A. You'll need to find alternative forms of payment.Q. My pharmacy plan only covers generic drugs, but I need the name brand. I tried the Generic Medication, but it gave me a stomach ache. What should I do?

A. Poke yourself in the eye.

Q. What if I'm away from home and I get sick?A. You really shouldn't do that.Q. I think I need to see a specialist, but my doctor insists he can handle my problem. Can a general practitioner really perform a heart transplant right in his office?A. Hard to say, but considering that all you're risking is the $20 co-payment, there's no harm in giving him a shot at it.Q. Will health care be different in the next century?A. No. But if you call right now, you might get an appointment by then.

Hugs, Jacy

~Nobody can make you feel inferior without your permission. (Eleanor Roosevelt)

jacymail@...IM: jacygal - ICQ: 96949087www.geocities.com/mtn_rose

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  • 3 months later...
Guest guest

In a message dated 5/20/05 7:33:11 AM Mountain Daylight Time,

SSRI medications writes:

> Managed care came about because Dr's abused their power and were

> billing for things they didn't do or weren't necessary. They are

> partly to blame for the system they now work within.

>

>

This is only partly true. There were a handful of doctors who abused the

system, and there are still some who do this, despite the hoops they have to

jump

through. The downfall of healthcare in this country began when they turned

healthcare into a HUGE BUINESS, a huge profit-based business, I might add,

where the bottomline is far more important than the health of the patient.

Aren't

HMOs traded on the stock exchange? Then they are madated by law to make a

profit, to hell with the patient.

" Blind Reason "

a novel of pharmaceutical intrigue

Think your antidepressant is safe? Think again. It's

Unsafe At Any Dose

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In a message dated 5/20/05 7:33:11 AM Mountain Daylight Time,

SSRI medications writes:

> Managed care came about because Dr's abused their power and were

> billing for things they didn't do or weren't necessary. They are

> partly to blame for the system they now work within.

>

>

This is only partly true. There were a handful of doctors who abused the

system, and there are still some who do this, despite the hoops they have to

jump

through. The downfall of healthcare in this country began when they turned

healthcare into a HUGE BUINESS, a huge profit-based business, I might add,

where the bottomline is far more important than the health of the patient.

Aren't

HMOs traded on the stock exchange? Then they are madated by law to make a

profit, to hell with the patient.

" Blind Reason "

a novel of pharmaceutical intrigue

Think your antidepressant is safe? Think again. It's

Unsafe At Any Dose

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Share on other sites

Guest guest

In a message dated 5/20/05 7:33:11 AM Mountain Daylight Time,

SSRI medications writes:

> Managed care came about because Dr's abused their power and were

> billing for things they didn't do or weren't necessary. They are

> partly to blame for the system they now work within.

>

>

This is only partly true. There were a handful of doctors who abused the

system, and there are still some who do this, despite the hoops they have to

jump

through. The downfall of healthcare in this country began when they turned

healthcare into a HUGE BUINESS, a huge profit-based business, I might add,

where the bottomline is far more important than the health of the patient.

Aren't

HMOs traded on the stock exchange? Then they are madated by law to make a

profit, to hell with the patient.

" Blind Reason "

a novel of pharmaceutical intrigue

Think your antidepressant is safe? Think again. It's

Unsafe At Any Dose

Link to comment
Share on other sites

Guest guest

In a message dated 5/20/05 7:33:11 AM Mountain Daylight Time,

SSRI medications writes:

> Managed care came about because Dr's abused their power and were

> billing for things they didn't do or weren't necessary. They are

> partly to blame for the system they now work within.

>

>

This is only partly true. There were a handful of doctors who abused the

system, and there are still some who do this, despite the hoops they have to

jump

through. The downfall of healthcare in this country began when they turned

healthcare into a HUGE BUINESS, a huge profit-based business, I might add,

where the bottomline is far more important than the health of the patient.

Aren't

HMOs traded on the stock exchange? Then they are madated by law to make a

profit, to hell with the patient.

" Blind Reason "

a novel of pharmaceutical intrigue

Think your antidepressant is safe? Think again. It's

Unsafe At Any Dose

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  • 2 months later...

From a bottom line perspective, being so resource intensive, it really is

not cost effective for stage IV patients to live more than five years. It is

frightening to think that even if not deliberate, that with the status quo,

insurance companies profit at ones demise. It is hard for me to comprehend

that they will pay out $7000 per treatment that destroys but would not pay $700

for a week of intense nutrition to actually heal. I have shared before that

working in health care from the administrative side that it is almost routine

that complications of chemo resulting in the final hospitalization is quite

often pneumonia which for DRG based payouts like with Medicare is one of the

higher paying reimbursements. Health care providers generating big bucks

while they can as the insurance companies would go bankrupt if " treatment " were

to continue for any length of time. Whether it is just the accepted same

ole, same ole or a deliberate profit incentive in not having a long term

survival is tragic reflection of our modern society although still to me quite

reminiscent of the Holocaust. Donna

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I quit chemo the second time around, before " I was supposed to " and have refused

all of their other drugs they wanted to put me on, the only thing I do is get an

MRI every 4 months to see if there are any new tumors, so actually I am a stage

IV patient that is no longer costing the insurance co very much!

C

donnadbd777@... wrote:

From a bottom line perspective, being so resource intensive, it really is

not cost effective for stage IV patients to live more than five years. It is

frightening to think that even if not deliberate, that with the status quo,

insurance companies profit at ones demise. It is hard for me to comprehend

that they will pay out $7000 per treatment that destroys but would not pay $700

for a week of intense nutrition to actually heal. I have shared before that

working in health care from the administrative side that it is almost routine

that complications of chemo resulting in the final hospitalization is quite

often pneumonia which for DRG based payouts like with Medicare is one of the

higher paying reimbursements. Health care providers generating big bucks

while they can as the insurance companies would go bankrupt if " treatment " were

to continue for any length of time. Whether it is just the accepted same

ole, same ole or a deliberate profit incentive in not having a long term

survival is tragic reflection of our modern society although still to me quite

reminiscent of the Holocaust. Donna

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  • 4 years later...

Lida,

It's a type of health insurance plan. It stands for Health Maintenance

Organization. Typically, it is cheaper to purchase an HMO plan than a different

plan offered (tho not always), but an HMO plan also typically covers office

visits and procedures at or near 100%. The problem is that you are restricted

with an HMO. Only certain doctors participate with the plan, so a highly

specialized surgeon (like a flatback surgeon) might not be part of the plan, or

considered " in-network " - in other words, that doctor doesn't participate in the

HMO plan and so they might not be covered if you choose to see them. Also,

every single specialist, and every test and procedure must be approved by the

insurance company before you have it done. Otherwise the plan will not pay for

it.

Some HMO plans have huge networks, so a person has many, many choices with who

they go see for medical attention. Other HMO plans may be very small, and so a

person has very few choices on who they can go to.

So an HMO can be a great thing for some people, but can make it awfully hard for

others - especially those people who need very specialized care.

If you google it, you'd probably find a clearer explanation than what I tried to

give :)

>

> Could someone tell this Brit what an HMO is.

>

> Lida in London

>

>

> Re: It Must be TIme

>

>

>

>

> C

> I read 's letter and rather than answering him separately (since it

> is late and I am about to nod off), I want to add that many of us US-based

> people, if not most of us, are in HMOs these days! Some of us in this group

> particularly may tend to have supplemental Medicare as well In my case the

> Medicare is my secondary payer, so the HMO gets billed first and I have to

> follow its rules for referrals. I did need to switch to a PPO temporarily to

> get my initial revisions done in Boston, but I am fortunate to have found

> topnotch surgical care and pain management closer to home now, and all my

> current docs are on the HMO's approved list. I've been through five more

> spinal revision procedures and a number of pain-pump-related surgeries with

> the HMO.

>

> Best,

>

>

>

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