n 12 days for a scheduled appointment with their primary care doctor... In more than one-third of the HMOs, up 50% of the members said consistently busy telephone lines and the mirage of phone numbers and transfers caused them to sometimes give up scheduling an appointment.... In 52% of HMOs, up to 50% of disenrollees said their doctors failed to refer them to a specialist when needed.... In 40% of the HMOs, from 11% to 50% of disenrollees reported the medical care they received from their HMO caused their health to worsen" (Evans and Kline 10).What happens when your physician and your HMO administrators do not agree? Lets look at the following case study. Sandy C. had struggled with her weight all of her life. Finally, when her 5'2" frame ballooned to 260 pounds, she was considered at high risk for hypertension, heart attack and diabetes (Kowal). Her internist recommended a stomach reduction surgery to curb her urge to overeat. According to Dr. John Cosgrove, who is chief of laparoscopy at Long Island Jewish Medical Center, "The benefits of the surgery for those classified as morbidly obese are clear. When you do this surgery, patients live longer" (Kowal). However, one year after this proposed surgical procedure, this obese young woman is still waiting. Why? Quite simply, Sandy's HMO refused to pay the $10,000 price tag, and the surgery could not be afforded otherwise (Kowal). Sandy's HMO determined that this procedure did not constitute a medical necessity and would create more problems than it would ultimately solve, and therefore, have repeatedly denied the surgeon's compelling efforts to cover the surgical cost (Kowal PG). Sandy is naturally upset and unable to understand her HMOs reluctance to authorize the surgical procedure, lamenting, "I work for a living, but I can't have surgery that my doctor says is necessary for my health. I think it is so unfair" (Kowal). Another case recently reported by MSNBC News, the sto...
