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Jack Sisson's Life Ethics Blog

We must find new ways through many ethical issues, especially regarding bioethics, medical ethics, and criminal justice. Jack Sisson's 'Life Ethics' blog focuses on numerous areas of concern, including the philosophical and ethical dilemmas surrounding stem-cell research, abortion, medical research, and health care.


Here's a 2009 article from Yahoo on HMO problems. As many of you know, Jack has a bone to pick (well, several bones actually) with HMO's, and we'll be writing about them from time to time here on the Life Ethics blog. There may be some occasional crossover with the TBI blog if brain injuries and/or mental conditions and HMO's cross paths in the same article. We'll also tell Jack's story in more detail at some point. But for now, let's just take a look at some of the more obvious problems one encounters with HMO's.
If you or anyone you know have had HMO problems, then you can understand how this type of medical insurance tends to send people screaming in the other direction. It may or may not save you money, depending on the problems you come across, and the illness you're trying to get treated. Some of the problems are common and you can get around them, others can be more difficult and cost you more money and time.
For example. Someone I know had a broken jaw. She went to a doctor listed with HMO and had her jaw set and wired together. It was like this for four months. Anyone who's had their jaw wired, knows this is no picnic.
After a month, she started having problems with her jaw. It hurt all the time and from looking at her, you could see the jaw was dropping and not aligned properly. She went back to the doctor, and was told the wire was growing into her gums, her jaw bone was not growing back together like it should, and that she would have to go through more surgery to fix the problem.
But here's the kicker, we discovered the doctor who did the original surgery, had just opened her practice, and had never performed this type of surgery before, and of course did not know how to perform the surgery needed to correct the problem.
So my friend was referred to another doctor who could do the procedure. The problem however is that he was not listed with HMO. The doctor had to go through hoops trying to get HMO to cover the procedure.
They needed proof, documentation and pictures before they would even consider approving her surgery. It took them one month to approve the corrective surgery.  In the end, it took a total of 4 months to get her jaw fixed, fifteen days from work, 25 pounds of lost weight, and more aggravation than you need to go through when you're sick.
The only thing I can fault her for is not checking out the doctor, the way we all should. Being listed with HMO doesn't mean anything, and it surely doesn't mean the doctor knows what they are doing.
So I've listed a few of the problems you could possibly run into with HMO, and how you can avoid them.
Check The List Of Doctors With Your HMO:
See if the HMO list has a decent supply of doctors in each category. Also check for the listings of medical specialists, like oncologists, cardiologists, neurologists, etc. It's better to have more than one doctor to choose from.
Choosing Your HMO Doctor:
HMO is like any other medical plan that exist today. They have a list of doctors you can choose from. Where you go wrong is choosing a doctor you know absolutely nothing about, and not scheduling an appointment with them - so you can ask questions.
Be very polite and ask them about their medical training, and if they have ever done the type of surgery you are scheduled for. If they won't or don't answer you questions, then you should find another doctor.
Even if they answer your questions, it doesn't mean you are going to like the answer. If you don't, find yourself another doctor.
HMOs may be a little reluctant in letting you change doctors, but if you insist, they will eventually agree. It is better to go through this, than using a doctor who you either don't like or can't perform the procedure you need.
Getting A Second Opinion:
Getting a second opinion can be rather tricky. Especially if you were referred to a doctor that happens to be a colleague or friend of your doctor.
If they both belong to your HMO, the second doctor may be rather hesitant to give an honest opinion, because he's afraid of offending his friend or colleague.
What you may need to do is go outside your HMO plan, and find a doctor that has no relationship with your doctor, and has nothing to gain.
You need to check with your HMO to see if they would cover a second opinion from outside the plan. If they don't, you might want to consider doing it on your own, but the money would come out of your pockets.
Continue reading.

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