The "Oy!" of HMOs
Frequently Asked Questions About Managed Health Care
--by David Lubar
Q. What does HMO stand for?
A. This is actually a variation of the phrase, "Hey, Moe!" Its roots
go back to a concept pioneered by Doctor Moe Howard, who discovered
that a patient could be made to forget about the pain in his foot if
he was poked hard enough in the eyes. Modern practice replaces the
physical finger poke with hi-tech equivalents such as voice-mail and
referral slips, but the result remains the same.
Q. Do all diagnostic procedures require pre-certification?
A. No. Only those you need.
Q. I just joined a new HMO. How difficult will it be to choose the
doctor I want?
A. Just slightly more difficult than choosing your parents. Your
insurer will provide you with a book listing all the doctors who
were participating in the plan at the time the information was
gathered. These doctors basically fall into two categories -- those
who are no longer accepting new patients, and those who will see you
but are no longer part of the plan. But don't worry -- the remaining
doctor who is still in the plan and accepting new patients has an
office just a half day's drive away!
Q. What are pre-existing conditions?
A. This is a phrase used by the grammatically challenged when they want
to talk about existing conditions. Unfortunately, we appear to be
pre-stuck with it.
Q. Well, can I get coverage for my pre-existing conditions?
A. Certainly, as long as they don't require any treatment.
Q. What happens if I want to try alternative forms of medicine?
A. You'll need to find alternative forms of payment.
Q. My pharmacy plan only covers generic drugs, but I need the name
brand. I tried the generic medication, but it gave me stomach ache.
What should I do?
A. Poke yourself in the eye.
Q. What should I do if I get sick while traveling?
A. Try sitting in a different part of the bus.
Q. No, I mean what if I'm away from home and I get sick?
A. You really shouldn't do that. You'll have a hard time seeing your
primary care physician. It's best to wait until you return, and then
Q. I think I need to see a specialist, but my doctor insists he can
handle my problem. Can a general practitioner really perform a heart
transplant right in his office?
A. Hard to say, but considering that all you're risking is the $10
co-payment, there's no harm giving him a shot at it.
Q. What accounts for the largest portion of health care costs?
A. Doctors trying to recoup their investment losses.
Q. Will health care be any different in the next century?
A. No, but if you call right now, you might get an appointment by then.