A 32-year-old woman, married with three children, was diagnosed with breast cancer. Her HMO denied her the thousands of dollars of care the HMO was obligated to pay for. It took 6 months for her family and friends to raise enough money to cover care for her at another medical center. She died. That 6-month delay most likely cost her her life. Later it was found that the director of the HMO that denied her care had no expertise in breast disease or cancer and was not even a practicing physician. It was also discovered that he received bonus pay at the end of the year based on how much the HMO profited. And while patients who had purchased their HMO membership were being denied treatment, employees of that HMO, who had the same breast cancer as the patient, did receive paid-for treatment from that HMO.

A young man with serious psychiatric problems was admitted to a psychiatric hospital. His insurance company put pressure on his psychiatrist to discharge the still unstable patient early. The insurance company's physician reviewer who pressured the psychiatrist was not a licensed psychiatrist. The psychiatrist acquiesced to the pressure of the insurance company even though he knew his patient was still unstable and after the patient was discharged the patient committed suicide.

A gentleman with medical bills of over $25,000 for care at a medical institution was told by his insurance company that they would pay approximately $6,500 worth of care because they considered the rest of the care not medically appropriate. The gentleman's family sued. The court found that the insurance company made up its own Standard of Care and did not adhere to nationally acceptable medical standards in making it's decisions.

A hospital was fined millions of dollars when a family sued because a family member was discharged too early from the hospital, to the detriment of the patient. The court found that the hospital pressured the patient's physician for early release when it discovered that the patient's insurance was about to run out.

A patient with an HMO did not receive proper cancer treatment at the HMO's participating university medical canter hospital because the staff was pressured by the HMO to not perform the proper care. The medical center was told that the HMO did not want to pay for the treatment and threatened the hospital that if it treated that patient the company would transfer all patients under their plan to another hospital.

A young man died of an acute heart attack after a nurse on an HMO telephone "help line" refused his wife's request to take him to the nearest emergency room.

WHAT YOU DON'T KNOW CAN HURT YOU

My Consumer Protection Health Care Handbook can fill in the blanks so you can protect yourself from situations like those described in the stories I just told you. Scary stories like those don't have to be in your future. I can help you prevent such things from happening to your family by educating you in ways to deal with HMOs and insurance companies and by giving you a game plan you can use while you navigate our current health care system. Of course, there are no guarantees, but if you have the necessary knowledge before a health care crisis occurs, you can minimize the chances of your story becoming a scary one.

© Copyright 2011 Dr. Anonymous. All rights reserved.