Q & A on HMOs
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 a 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 get sick.
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 out is the $10 co-payment, there's no harm
giving him a shot at it.