A question about HMOs?

Question

Im not addvocating violence or anything. But lets say you have terminal cancer and your HMO denies you coverage and you will certainly die because they are cheap. Since they give such little value to your life, should you reciprocate?

Answer 1

Blame the US Supreme Court that allowed this to exist.

Answer 2

I can only speak for California but we are lucky as the leading HMO plans in my state cover more and are easier to work with than in other states. That being said....

You're covered under an HMO and are diagnosed terminal. You do have coverage and as long as you follow the rules and regulations of your plan (your oncologist and other specialist are in the same medical group as your primary care physician) your treatment cannot be declined if it is medically necessary. In fact, the big HMO's offer Center's of Excellence which will basically cover the leading cancer treatment centers as IN NETWORK benefits.

Even if your plan denied benefit that are stated in your benefits book (EOC) take it to arbitration and leave the dramatics at home.

Answer 3

Remember, most HMO's are Non-Profit organizations. They can only spend on peoples health care the money that they bring in. If your care isn't covered by the language of the contract, but they pay for it anyway, that money isn't available to pay for someone else's care.

There's a fixed amount of money available. What your HMO spends to pay for YOUR care, they can't use to pay for MY care.

HMO's don't deny coverage because they're cheap, or don't care, they deny coverage because the coverage isn't included in the terms of the plan, and they only collect enough money from the members to pay for the care that IS included.

Richard