Relay-Version: version B 2.10 5/3/83; site utzoo.UUCP
Posting-Version: version B 2.10.2 9/18/84; site milo.UUCP
Path: utzoo!watmath!clyde!bonnie!akgua!sdcsvax!sdcrdcf!hplabs!hao!seismo!umcp-cs!aplvax!milo!eric
From: eric@milo.UUCP (Eric Bergan)
Newsgroups: net.med
Subject: Re: DRG/HMOs and quality of Patient Care (provocative)
Message-ID: <789@milo.UUCP>
Date: Sun, 23-Dec-84 11:44:48 EST
Article-I.D.: milo.789
Posted: Sun Dec 23 11:44:48 1984
Date-Received: Thu, 27-Dec-84 02:37:29 EST
References: <> <147@ski.UUCP> <6743@brl-tgr.ARPA>
Distribution: net
Organization: JHU/Applied Physics Lab, Laurel, MD
Lines: 24

> 	I, too, find certain advantages in an HMO.  However, I suffer
> from a chronic, presently uncurable neuromuscular disease.  If I don't
> get the correct treatment, I could be totally unproductive, even die.
> The most competent care for this nearby is at the Johns Hopkins Medical
> Institutions and a few "outside" neurologists with staff and adjunct
> faculty priveleges there.  I have yet to see an HMO that would allow me
> to see these people and be treated at Hopkins.  Am I wrong?
> 

	While not on the same level of seriousness, my wife required jaw
surgery about a year ago to correct some orthodonic problems. Our HMO
does not have an oral surgeon capable of handling the procedure, so they
allowed us to go to one outside the plan (at Johns Hopkins, as a matter of
fact), and still picked up the bill. I won't say it was easy, but after a
doctor from the plan examined my wife and determined the surgery was 
necessary, and not merely cosmetic, they did let us proceed. As insurance,
I also made sure I had a written statement from them saying they would
cover the operation. But there was not any problem, and the surgery occured
without hassles. I don't know if all HMOs are like this, but mine certainly
handled it in the way I thought most reasonable.

-- 
					eric
					...!seismo!umcp-cs!aplvax!milo!eric