Word: hmos
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Dates: during 2000-2009
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...graduated with me from medical school in the mid-'70s are working 50 to 60 hours a week, almost as hard as they did as interns, just to make ends meet: to pay their rent and nurses and other office expenses on the highly reduced reimbursements they get from HMOs, Medicare and Medicaid. And then a huge part of what is left over goes to pay for malpractice insurance...
Think you've got problems choosing a health-care plan? Consider Michael Scarpa, benefits manager for the 13,000 U.S. employees of ABB, the power-and automation-technologies giant based in Zurich, Switzerland. Until recently, as contracts expiredevery May, 20 HMOs in 40 states would send in six-inch-thick binders containing detailed bids for ABB's business. Scarpa, 37, and his staff would spend days plowing through the paperwork. Then Scarpa would often pay a consultant as much as $45,000 to analyze the bids for each contract up for renewal...
...also have long sent patients south. But cross-border medical HMO plans for the general population wereunheard ofuntil the mid-1990s, when Sistemas Medicos Nacionales (SIMNSA), a Tijuana-based HMO, began selling policies to employers in the San Diego area. At the time, there were no rules governing Mexican hmos selling insurance in California. "It was not legal, but it was not illegal," says SIMNSA president and ceo Frank Carrillo. "It was just sort of a gray area...
California officials decided to regulate the plans rather than shut them down and lose the benefit of low-cost health coverage in a state where an estimated 4.5 million are uninsured--more than half of them Latino. In 1998 California passed legislation that allowed Mexican HMOs to operate in the state, provided they offer benefits solely to Mexican nationals. SIMNSA was granted a license in 2000. So far, it is the only Mexican HMO approved to sell cross-border policies in California...
California law provides that patients treated in Mexico through hmos licensed to operate in California have the same rights as those receiving care in California. This includes the right to an independent medical review and the ability to sue the insurance company. (Suing a Mexican doctor is more complicated, however, because it must be done under Mexican law). "It will certainly be interesting to see the litigation that comes out of this," says neurologist Grisolia...