xcept for emergencies, all care must be authorized by a primary care physician, limiting access to specialists. In fact, when attempting to get a referral says Dr. Stephen Cohen (Founder of Physicians Who Care, MSNBC internet 1999) When the person on the other end of the phone line doesnt even know how to pronounce the name of the disease, its ridiculous.. If a referral is granted, according to the HMOs guidelines, the choice of doctors is usually limited and those contracted by the HMO may not have the expertise to treat the medical problem. Grievances must be handled by an appeal to the HMO, the same entity which denied care in the first place. Moreover, the grievance process can take months or longer, in some cases resulting in serious harm to the enrollee. There are no statutes in place to allow for malpractice cases against HMOs, enrollees are usually forced into a binding arbitration case. Under federal law, workers enrolled in employer-sponsored health plans can sue their HMO to recover the cost of treatment that was wrongly denied, but they cannot go to court to seek compensation for pain and suffering and to seek punitive damages. (Dallke) Patients are not the only losers in the web of the HMO scheme. Physicians are also becoming victimized by HMOs as are their patients. But in this case, it is financial rather than physical. Like HMOs, physicians are paid a fixed amount for each patient, and this figure does not vary. In other words, if the patient doesn't show up for treatment, the amount is not adjusted. What this means is that if there are any savings, the physician benefits. However, when there are not, which is most often the case, the physician, not the HMO, assumes the liability. Simply stated, "The patient is costing the physician money the minute she walks in the door" (Evans). Managed care replaces Hippocratic ethic with veterinary ethic. The owner paying the bill, the HMO, makes the decision. If they dec...
