HMO Squeeze

The article “Doctors and Patients Feel Squeeze From HMOs” on Sept. 4 was interesting indeed. It is also quite disturbing for me and pinches a raw nerve or two in me. I believe that I’m personally enjoying the bitter experience of encountering the squeeze from an HMO.

I’m a former state employee with a reasonable health plan to cover my dental needs, so I thought. A year ago I claimed a dental service from my health provider, and eight months later, after much wrangling, my claim was approved. I was happy to finally receive much-needed dental care. I was wrong. Instead of sending me to the “nearest office,” as my agreement with the insurance provider stated, I was directed to El Segundo.

I believe that there is need for legislative reform which requires procedural changes designed to ensure that medical decisions are based upon medical rather than entrepreneurial considerations (By the way, the insurance provider insists that I visit its El Segundo office for the reason that the insurance provider owns it.) Therefore, Gov. Wilson should sign the components of this reform, AB 3801, SB 1348 and SB 1832; especially AB 3801, which requires disclosure of administrative costs.

In the meantime, I am waiting, waiting for a response to my appeal. Who knows, I may get an answer--around Christmas. As the song goes, “All I want for Christmas is my two front teeth.”

ADOLPH DONINS

Oxnard