A Patient’s Complaint With His HMO

Vince Reel’s “Gripe” (Voices, July 19) with the HMO, which left his cancer undiscovered and untreated for two months while his weight dropped 50 pounds, raises yet another question. Reel quit the HMO and got his treatment from a fee-for-service doctor. Who gained from this despicable incident? The HMO! The very wrongdoer that caused it.

Medicare HMOs are paid 95% of the average monthly expense of caring for a person in the traditional setting. They get this every month, whether the patient is sick or well.

By conspiring to give wretched service, they drive away the patients when they get sick back to the traditional sector. Thus they are paid in advance to give needed treatment in the future, but arrange to dump that responsibility back on the taxpayers.

Medicare HMOs are breaching their contracts with the government and enrollees. The law should require that any medical expenses incurred in the traditional sector within six months of an enrollee switching out of an HMO should be charged back to the HMO.

HARVEY S. FREY MD, PhD

Director, Health Administration

Responsibility Project

Santa Monica

As an administrator at an HMO I found it irresistible not to respond to the article by Reel and “Tips for Health-Care Consumers” offered by Jamie Court.

Reel states that he had not seen a doctor in two decades and he had been symptomatic with frequent urination for several years. For months his symptoms slowly escalated but he did nothing till he found himself in distress at 2:23 a.m. on a Sunday. He says he went to the nearest emergency room where he received good treatment. What he should have done was call his HMO and be directed to the nearest emergency room that is part of the HMO’s network.

When Reel enrolled in his HMO he was grateful that the premium was low, or as in the case of Medicare, nonexistent. But when he received his membership booklet explaining how the system worked, how he should visit his primary care doctor for a checkup within four months of joining, and how he could talk to a member’s representative if there was a problem; he must not have read it.

Court’s tips are all factual; complaining to the regulators will get the HMO’s immediate attention. But before becoming angry, become informed. Know how your HMO functions; contact the primary care doctor you’ve selected from the network panel. If you don’t like the doctor when you have your initial physical exam, that is the time to make another selection, not at 2 a.m. on a Sunday morning.

THOMAS M. HERIC MD, PhD

American Family Care

Long Beach

HMO horror stories will become more and more prevalent. The public will be able to evaluate the denial of needed medical care or hospital stay if you publish with each story the annual compensation, salary, bonus and stock options of the CEO of the HMO that denies the needed care.

The total compensation will purchase how much care?

DOROTHY SCHATZ

North Hollywood