Word: hmo
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...answers. A few do need money because of mounting medical bills. Expenses for Richard Castaldo, who is paralyzed from the waist down, could top $1 million. Mark Taylor, who has had four operations and faces a long, painful road to recovery, needed an $1,800 therapeutic mattress, but his HMO refused to pay for it, and the family had to find other means. "If the insurance companies aren't doing their job," asks Donna Taylor, "then what are we supposed...
That sounds to some critics like precertification by another name. "It can't be assumed these guys are behaving in the interest [of patients]," says Judith Feder, a health-policy expert at Georgetown University. Maybe not, but last week's decision demonstrated that even self-interest can start an HMO down the right path...
...last week the HMO world produced a surprising decision that could delay or derail that bill in Congress. United HealthCare, the nation's second largest managed-care company, pulled the plug on precertification. The company, which is based in Minneapolis, Minn., and covers 14.5 million Americans, is betting the move will improve the quality of care and its bottom line, and maybe even help convince Congress that the HMOs can heal themselves. Nearly everyone applauded the decision, but practicing physicians were cheering loudest. Says cardiologist George Rodgers, in United's Austin, Texas, pilot program: "It's just made my work...
Opponents of the HMO legislation, whose final passage was always doubtful in view of the Senate's opposition, argue that United's move shows the bill is moot. "The market is far ahead of politicians," says Karen Ignagni, president of the industry trade group, the American Association of Health Plans. But proponents of the bill argue that as long as most HMOs resist going United's way--and they will until it is clear that the company can manage costs without micromanaging its doctors--patients will need the protection that comes from the threat of a lawsuit. "We need...
...Patients, already struggling with HMO gatekeepers, are facing a new level of interference from religious gatekeepers," says Lois Uttley, director of MergerWatch, an organization that campaigns against mergers between Catholic and non-Catholic hospitals. Campos intends to tear down that gate. She doesn't want to have her baby at St. Louise and her tubal ligation at another hospital two months later. "I'm going to put up a fight," she says firmly. "I have the right to make a choice." Perhaps St. Louise should consider what wise men inevitably learn: it doesn't pay to argue with a pregnant...