Right off the bat, the acronym 'HMO' conjures a negative connotation. Since their inception and quick transformation to what we refer to as HMOs, we were doomed. HMO's lost their identity and true purpose. They are, in fact, Health Maintenance Organizations, not medical insurance in the traditional sense of the word. We easily forget or we have selective memory. We go out and sign up for an HMO to save money (which it does). Then we complain because it doesn't perform like our old, true blue medical insurance. LOOK! If it waddles and quacks, it's not a dog!

Every one knows insurance companies don't want to pay claims. That's not how they make money. The prime directive of HMO's is to maintain health, through their plan of routine check ups and testing. They are not concerned if you have a pain and they do not, repeat, do not want to refer you to a pricey specialist. They want your Primary Care Physician to handle the bulk of your issues right there. Specialist referrals are a last consideration, after you have jumped through every conservative treatment hoop known to man. (They are hoping you will just give up and go away.)

I don't have a statistical analysis or break down of our health care system. No quoting facts and figures here to boggle your mind. No TV news reports or newspaper articles to cite. Just a glimpse at what I see at work everyday. This is what a typical day is like for me and my patients. So, bear with me, because the subject sends me on somewhat of an emotional roller-coaster,

Don't worry. I don't intend to deposit the HIPPA laws into the toilet, as it were. This is a byte of actual occurrences, cloned on a daily basis. And this is not "Ripley's Believe it or Not". This happens to you and your parents and neighbors every day. I want to impress this upon you, so that you understand, these aren't isolated incidents or the worst of the worst. It's oh, so dreadfully common.

Mr Fishy's Sales Pitch Stinks!

For HIPPA sake, names are fictional. The stories, sadly are true.

Mrs. Hoodwinked, a patient of Dr Rolex, made an appointment with the doctor. Her appointment date arrives, as does she. She is assisted by Glenda at the front desk. When asked for her insurance cards, she promptly hands Glenda her Medicare card and her Senior HMO Plan card. Glenda tries her best to determine which is the correct card, when she called for my help. Mrs. Hoodwinked insisted she had both, which is possible, but we could only accept Medicare for this visit. (We did not have a referral from the HMO for her). Glenda tried to confirm her eligibility with Medicare, which showed her inactive. The HMO Senior plan proved to be her active plan. Mrs. Hoodwinked had no idea she had actually surrendered her Medicare when she signed up for the HMO. She still had her Medicare card, so how could that be? I had to sit down and explain to her what the insurance salesman , Mr Fishy, did not.

There are so many Senior plans popping up claiming to be their health care savior. Each individual must ask the questions important for their medical needs. One plan may work for you just fine and save you money. But, buyer beware.

The only problem with the plan Mrs. Hoodwinked had purchased, was she did not understand her benefits and limitations. The problem I find, is the misinformation to out-n-out lies peddled by the sales agents to obtain commissions.

One woman asked Mr. Fishy, "Won't I lose my Medicare benefits, if I sign up for this plan?" His answer skirted the letter of the law and blew the spirit of the law all to hell. He said, "No. You never lose your Medicare benefits."

Technically, he was correct as she didn't lose her Medicare, but she sure can't USE it.

The Old Bait-n-Switch

Moving right along. Joe Baitnswitch came in to see Dr. Carver, who confirmed he would need routine surgery. Considered a major surgery, but very routine and required approximately a 3 day stay in the hospital. Mr. Baitnswitch had excellent insurance. Medicare as primary and a Full Coverage supplement.He did all the pre-op; he's fit and ready to go. He goes through with the surgery, and comes in for his post-op and he's doing fine.

Somewhere along about the 8 week mark, Mr. Baitnswitch calls the office in a tirade, demanding to know why he has received this bill! I will edit all the expletives and cut to the skinny, so to speak.

It seems that Mr. Baitnswitch had been talking to Mr. Fishy-big surprise! Mr. Fishy tells the man how much money he would save on his surgery and hospital costs by switching to an HMO Senior plan. So, that's just what he did. His plan became effective the day before his surgery and his Medicare was deactivated concurrently! Now tell who benefited here? Mr Fishy is the only one who came out smelling like a rose! Be a proactive patient-Ask the important questions like-

• Are all or some of my doctors providers?

• Will this plan be Solo-primary insurance? Or a supplement to Medicare?
• Do I have to change Primary Care Doctors?
• Can I have my xrays there (or 3rd location)?
• Do I need a referral from my Primary Physician?
• Do I have a choice of hospitals?
• Get 2nd & 3rd quotes on other plans

You can find more helpful information here @ Revive Your Health Care.com Talk to the office staff in your doctors' office. We will tell you the truth. It's in our best interest as well as yours, that you understand your coverage, as well as your responsibilities. For instance, it is your responsiblity to get your own xray films; to schedule and keep your appointments. Don't assume this will be done for you. It won't.

Don't wait for changes in insurance and Medicare laws to trickle down to the evening news. Be alerted daily to your email on the issues that concern you. Subscribe for free @Medical News Today.com

I believe there is a place for HMO plans and they have the ability to augment your medical care. Not every patient, however, can benefit from them. For instance, if you suffer greatly from rheumatoid arthritis and require a rheumatology specialist to monitor you. You need to make sure a rheumatologist is contracted in your area. If you've had a major heart surgery or condition, you really want YOUR own cardiologist to be contracted. You may need a plan that doesn't limit your access to the specialists necessary for your personal continued health. Saving a few bucks shouldn't be your only consideration when selecting health care coverage. It literally, could mean life or death. To YOUR good health!