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What the hell happened to the health care system

serazin — Fri, 28 Nov 2008 11:53:04 -0800

I don't understand why health care suddenly costs so damn much. I can understand a few factors - nurses' pay has gone up, new treatments are more expensive (and doctors prescribe more expensive treatments - sometimes unnecissarily) but these factors don't seem to explain how insanely costly health care has become. And where is all that money going? Again, I understand that CEO pay has skyrocketed in the last 20 years, but is that enough to explain the enormous cost of health care these days? Another area of confusion for me is how little time doctors (and nurses) can now spend with patients. I understand doctors are pressured to see more patients, but how does that work on a practical level - has the ratio of primary care providers to patients changed significantly in the last 10 or 20 years? Is a higher percentage of the population seeking health care? If not, how can it be that each doctor is seeing so many more patients a day? I'm confused!

Oh, okay, I wasn't aware that anal bleeding was such a pedestrian concern-- thanks, Doc.

Anonymous — Tue, 11 Nov 2008 20:33:40 -0800

TMI Medical Filter: Previously, I had sometimes crippling stomach pain. That went away. Now I'm, uh, bleeding. Rectally. Um. Yeah. But my HMO doesn't seem to care all that much. MetaFilter is not my doctor, but I can't go to my doctor to ask... should I skip my HMO and go to the hospital? Demographics note: Caucasian male, 20 years of age, only other major prior health problem--familial (?) migraine headaches.

Around August, I started having these awful, crippling bouts of mid-torso (stomach-area) pain in the morning and night, accompanied by abdominal bloating and upper-back pain. This continued for a week until I stopped being a moron and went to see a gastrointestinal doctor through my HMO, who put me on a preliminary regimen of Prilosec and ordered a round of tests.

For awhile, these bouts subsidied (with no word from my doctor RE: my tests), but then mid-September they began again for no readily apparent reason, prompting me to schedule another appointment, which I was not able to get in until October. I learned that apparently turned up negative for my H. Pylori scan (which apparently is predictive of having an ulcer?), though my HMO/doctor lost (!) all of the other related tests (I don't even recall all of them--one of them was an "occult blood" test). My doctor quibbled about perhaps performing an endoscopy, but would not commit to any further orders.

With a significantly increased dosage of Prilosec, the painful episodes had until recently subsided into occasional odd, funny, light pain in my stomach that I had been unaccustomed to feeling prior, but nothing that interfered with going along my day-to-day business. I had largely put that out of my mind until a few days ago, when I started to bleed rectally at almost every defecation. This began as a few drops or a bloodiness of the feces, but in my very subjective perception seems to have gotten steadily worse day-by-day. Accordingly, I've made an appointment with my doctor, but it won't be for another two weeks!

I've been calling for the past few days to try to catch a dropped appointment or see if any doctors at associated facilities have openings, explaining my circumstances, but have had absolutely no luck. Today, my bottom-torso even hurts some.

My own self-diagnosis was Meckel's Diverticulum, but, uh, then I noticed that this is mostly diagnosed at youth, and really, I don't understand anything. The symptoms seem to match me exactly, though (minus the, uh, life-threatening ones, as far as I know).

These are a lot of words to ask: At one point should I say "fuck you!" to my HMO and decide to seek some ER help at one of my great local hospitals? Is this potentially life-threatening in the immediate term? Should I have said "fuck you" the moment I started bleeding? I'm worried about incurring unnecessary hospital costs as my family and I are in a difficult financial situation (though I'm lucky to have healthcare at all, I suppose). If it helps at all or if anyone has any experience working with them, my HMO is Kaiser and I live in the Northern Virginian area.

Kaiser, Blue Shield, or Cigna HMO in Northern Californai?

names are hard — Fri, 05 Sep 2008 15:53:26 -0800

In Northern California, which is the best: Blue Shield, Cigna, or Kaiser (All HMO). I just started a new job (San Francisco) and get to choose from these three. I had a blue cross/blue shield PPO on the east coast, but I know they often vary by state. It seems like this question hasn't been answered for a bit, so what has people's experiences be.

Also, they will all cost the same, so that is not an issue.

I have a choice, do I want an HMO?

Mozzie — Tue, 09 Oct 2007 14:20:15 -0800

I have a choice of going on my employer's insurance plan or staying on the insurance plan my husband's employer offers. My plan would be an HMO with low co-pays and great coverage (100%), but it's an HMO. Everything has to be approved in advance, etc. My husband's plan is an EPO, with slightly higher co-pays, and all that. The difference in monthly premiums is slight ($50). What to pick? I'm in good overall health with no chronic conditions, or prescriptions of any kind. My doctor and his group/hospital are in both networks. The only benefit I've ever used on a health plan, other than a few office visits, is mental health and that was many years ago. But for mental health, my husband's plan allows more visits. My gut feeling is that either one is good for now, but if I get a serious health issue I'll wish I didn't have the HMO and it's approvals.

Is my impression of HMO's correct? Does being in an EPO suck in a different way? On the HMO, everything is covered 100% so long as you get the referral, etc. That is pretty tempting...

Help me deal with my health insurance company.

desjardins — Tue, 04 Sep 2007 12:39:33 -0800

I'm scared to talk to my health insurance company regarding a denied claim and further needed treatment. I moved across state lines recently and decided it was a good time to find a regular doctor. Potential mistake #1: I did not notify the insurance company that I wanted to switch doctors (I haven't seen the one listed on my card in years). Mistake #2: I assumed routine physicals would be covered under my plan. Apparently not, since I received a notice saying that none of the charges were allowed. One of the charges was for an ultrasound. They found something suspicious on the ultrasound and I need to get an MRI to figure out what it is. (I'm definitely not pregnant, FYI.)

I am really quite naive when it comes to health insurance matters. I don't understand how all this stuff works. I'm not even sure what the difference is between an HMO and a PPO, or which one I have (it's CompcareBlue, and I have a group # on my card). I just know that all my charges up to now (mostly therapy) have been magically covered. Also, I am not the most assertive person when it comes to dealing with faceless corporations.

So, how do I find out whether the MRI will be covered? Do I tip them off that I could possibly have some serious health problems? Do I try to get the physical/ultrasound covered, or do I assume that because they said it's not allowed, it's a lost cause?

How many times do I really have to get on the scale this year?

divka — Tue, 14 Nov 2006 13:59:03 -0800

What sort of doctor should a young woman have as her primary physician? Until now, I've always had a limited doctor choice through an HMO. So, I've always picked an gynecologist as my primary physician--and seen that doctor for everything from pelvic exams to allergy issues. Now, I have a honest-to-goodness "real job" with great health insurance. I don't even need to pick a primary care physician--I can see who I like.

So, do I pick a general practice doctor as my usual doctor? And if so, will they do my annual lady-type exam and dole out birth control pills? Or should I pick a gynecologist for my usual doctor. And will they not do general practice medicine (basic physical, etc.) usually on a PPO plan? Do most women end up using multiple physicians?

(FYI, I have no major health issues other than an impressive list of allergies. Also, if anyone lives in the Bethesda or Rockville, MD area and has doctor recommendations--please share.)

HMO no wanna talky.

evil holiday magic — Tue, 20 Jun 2006 14:25:59 -0800

How do I maintain communication while dealing with HMO? My mother was recently diagnosed with an early stage, slow growing form of cancer in the uterine lining, which we were informed would give us the luxury of about a month to figure out treatment options. The OB/GYN who'd done the initial biopsy (and would be doing the surgery) referred us to a couple of doctors for an office consultation, and they discussed the options in detail. One of the doctors was very communicative and helpful. We took notes of what options were recommended (D&C and Progesterone IUD; or a hysterectomy), and it was understood that we would consider the options and would have to go to another specialist for further consultation before deciding on a path of treatment.

She's been living with multiple sclerosis for about fifteen years, so we had concernss. We consulted with her neurologist to go over treatment options and find out what conflicts, if any, might occur between hormonal and surgical treatments offered, and her MS medication (Copaxone) or even the MS itself. Stress on her, even emotional stress, can cause a flare up, and that's what we're trying to avoid.

Shortly after the first consultation with the two doctors to which the OB/GYN had referred us, the OB/GYN, who'd admitted no specific knowledge of MS, has been pushing for a certain path of treatment (D&C and Progesterone IUD), and his only communication with us on the matter has been through broken-english speaking assistants who only want to nail down the surgery schedule (to do what he's unilaterally decided).

The neurologist and other people we've talked to who've had cancer experiences recommended the hysterectomy instead, but they admittedly also lack knowledge one way or another specific to this case. We have tried contacting the OB/GYN's office to talk briefly about the path he pursues so aggressively, but our messages are only returned with solicitations to pin down a surgery date.

I'm no self-styled internet doctor, but even as a layman I want to hear that there's a logic behind the recommendation of one treatment over another, if only to know that there is a logic. The path the OB recommends may be the best, but the fact that he won't discuss it with us gives us no confidence in him. The stress of imminent surgery is stressful enough, which is why it's absolutely essential that my mom can be assured that all factors have been considered.

So...

Any recommendations for dealing with this doctor and this situation?

How to Pick a Doc in a HMO/PPO? Chicago Loop Recommendations?

WCityMike — Sun, 04 Jun 2006 00:04:29 -0800

A twofold question, both procedural and specific, about doctors, insurance plans, choices, research, and, optionally, the downtown Chicago Loop area. The specific aspect of the question: does anyone have a recommendation for a general practicioner or internist (what's the difference between the two?) who has an office in the downtown Loop area (and I do mean strictly in the Loop, as I need to be able to schedule an appointment on a lunch hour)? And, if you do have a recommendation, what do you like about them?

The procedural aspect of the question: assume I've taken a list of doctors from my insurance company's database and narrowed it down by my geographic requirements above already. By what method and using what resources can I take this list and gain enough information about their temperment, demeanor, and "bedside manner" to make a choice I'll be happy with?

How do we get the HMO to work with us?

evil holiday magic — Sun, 08 Jan 2006 19:20:22 -0800

My parents are members of an HMO, but our dealings with them have been frustrating, and we need help. (*Catheter references inside.) My parents are members of a popular HMO, and my mom has multiple sclerosis. She has been luckier than many who have it, but a product of it is that she's been catheterized. She's been good about flushing the hose with saline, but sediment from her vitamins and medications does cause it to eventually clog -- usually earlier than the monthly schedule issued by the HMO.

When she first started the catheterization program, my parents would go off to the hospital (exposing themselves to germs) to get the catheter changed. A nice nurse later revealed to us that all along my mother was qualified to have a nurse come to the house to do it when necessary. This worked well for a while.

More often, however, we end up with a nurse (we'll call her the 'bad nurse') who we don't think has much regard for us. We were told by a couple nurses at the HMO that the standard change schedule is one month, and anything off that schedule must be requested on a case by case basis.

* On several occasions, my mother's made requests for changes, only to have days pass, before my father (who received a perfunctory training on this) finally had to change the catheter himself late after work.

* We've asked several questions of the the bad nurse, only to get contradictory answers. We've checked up on simple requests we've made for standard supplies (which she agreed to) only to find that they were never followed up on.

* I noticed the bad nurse's case notes were completely wrong regarding the nature of my mother's incontinence.

* My mother has complained that the nurse's method of installing the catheter is painful/disturbing by comparison to that of the other nurses.

* My mother's questions or comments are often met with unexpected accusations of her not taking her medications.

We want to get a different nurse to come in (several kind and gentle nurses, who've gotten along well with my mother and the rest of us, have offered to be the one to come here each time), but the 'bad' nurse also happens to be the case manager, and is the most local to us; so even when we request someone other than the bad nurse, from her superior, we often end up with her anyway.

We don't know what our rights or options are, and the bad nurse is stonewalling us.

Should I pay or file for coverage for therapy?

barnone — Mon, 07 Nov 2005 09:22:19 -0800

I'm thinking of seeking counseling for a variety of reasons. Being new to the US however, I have questions about how therapy will have an effect on my future health care coverage. Should I pay out-of-pocket or file for coverage? I have Blue Cross/Blue Shield in the US, and if I use someone in-network, they cover 80% and if it's out of network, it's 60%. I could just pay out-of-pocket - it would stretch me, but I would be willing to make sacrifices elsewhere to let it happen if it was really worth it. But, I pay enough in health care coverage already, that if it makes sense to use it, I will.

My question is this: how does seeking mental health help effect future a) employment b) health care coverage/prices c) anything else?

I know that the HMO will need a 'code' from the therapist as to a diagnosis for appropriate charges. That doesn't concern me as much as future implications for that diagnosis. Who can access that information? What would they know? Will this matter?

I'm not paranoid of 'ohmigod mental health stigma' but I would just like to make an informed decision based on future possible implications. This is the first time I've ever really dealt with the US health care system, and it's a little overwhelming.

The Ugly Organ

Mach3avelli — Tue, 13 Sep 2005 08:48:22 -0800

Is it a smart idea to keep a donor sticker on your license? I've heard rumblings.... that, due to the nature of long lists of organ transplants, there won't be as much effort to save you if you're on the brink. I don't have any EMT friends, but a doctor I spoke with was pretty ambivalent about giving me a clear answer. I've heard this fluttered around from several different people, so if anyone can shed some light on the reality of this situation, I'd like to know.

asperger's vs. adult add?

SpecialK — Sat, 18 Jun 2005 21:53:48 -0800

I have always had attention problems, but when I was tested in 1993, the tests came back inconclusive: the neuropsychologist concluded that only 7% of my 'issues' was ADD. That was twelve years ago. In my adulthood, I'm having serious problems concentrating, but am unsure of the effects the common ADD medications will have on me, and I'm curious if there are different treatments for attention deficit due to adult ADD and due to other 'issues'. Other information: I'm heavily self-medicated with stimulants, most notably caffeine. I've tried to cut back, but I still consume at least 36 ounces of caffinated sodas per day. (I don't like coffee, it tastes like mud mixed with Fat Bastard's toilet leavings to me.) When I, noting the health effects of consuming that many empty calories per day, cut caffinated sodas out of my diet, my life and my business started to fall apart. Having experimented with caffeine as a stimulant over the past year, (cutting it out of my diet and adding it back in), I'm finding that I require it to focus enough to accomplish anything in a day. It's not the sugar; drinking decaf but sugared sodas has no effect on me.

Commonly available psychoactives and OTC drugs (exotic alcohols like asbinthe, marijuana, claritin etc.) can have extremely unintended effects on me. Claritin, for instance, will make me extremely depressed for three days after one dose. Marijuana will make me extremely paranoid. We're not going to discuss what asbinthe did to me the one time I tried it. I've completely stopped experimenting with drugs and am extremely hesitant to take *anything*, even presecribed ('cept antibiotics), lest it unbalance me in some strange way. I've always overcome psychological or behavioural issues with a focus on self-discipline and 'self-counseling sessions', but this seems to be unsurmountable.

My experimentations with caffeine have lead me to the conclusion that I need a stimulant for my particular brain chemistry to avoid the 'ooh, shiney!' effect. I do have a long history with an undiagnosed learning disability that involved several processing disorders and a small degree of ADD when I was tested for it in the early 90's (before the asperger's diagnosis made it into the psychologist's version of the physician's desk guide, or was really even heard of); the symptoms and childhood behaviour led my mother to one day email me a scan of the list of Asperger's symptoms from one of her education trade magazines (we're not talking Newsweek here) with each line checked off in red magic marker... and then another list of adult aspergers' symptoms, which also almost precisely matched me.

Having had long experience with my particular HMO, Kaiser Permanente, I know that I need to go in with a clearly defined set of problems and researched potential resolutions to get anywhere. My mental health coverage is minimal, so I'd like help doing research in advance while avoiding the trap of self-diagnosis (Which, yes, I realize I've mostly fallen into. Bear with me...). If I don't go in with that clearly defined set of issue and resolutions, they'll milk me until my coverage runs out and I have to start paying out of pocket for mental health office visits.

How can I focus my requests to the mental health professionals at my HMO in order to get some sort of treatment for my inability to focus or maintain personal discipline without a chemical stimulant, or are there other resources I can seek out to help figure out why my brain needs to be fueled by caffine to get anything requiring focus completed?
Also, does anyone have any stories they'd like to chip in about overcoming psychological or behavioural problems that might help me overcome this issue, with or without medication?

Health Insurance

carter — Tue, 05 Oct 2004 11:51:29 -0800

Health insurance: CIGNA vs. Kaiser Permanente. My employer offers a choice of partially-subsidised HMO plans with either CIGNA or KP. KP seems a lot (about 50%) cheaper, but my co-workers seem to prefer CIGNA. Is there a catch? Are they being snobbish? Are KP bad? Or are they just more efficient because they do everything in-house? I'm assuming that either will be a step up from the provider at the student health centre.