Tuesday, October 7, 2008

I Don't Give a Bleep About-HMO's

A health maintenance organization (HMO) is a type of managed care organization (MCO) that provides a form of health care coverage in the United States that is fulfilled through hospitals, doctors, and other providers with which the HMO has a contract. The main purpoe of this organization (and I use that word loosely).

OKay so why am I going into this brief description, because anyone that has to deal with and HMO knows it has some crazy guidelines. I have a friend and I use to have this as well, whose company issues FSA's (Flexible Spending Account).

This will generally allow an employee to set aside a portion of his or her earnings to pay for their medical expenses but often for dependent care or other expenses. Money deducted from your paycheck into and FSA is not subject to payroll taxes, resulting in a substantial payroll tax savings.

Okay, this was suppose to (years ago) be this simple way to expedite and assist people get medical care. I don't know about you guys, but I watch the discussions (debates) about the Health Care issues (and the proposed solutions) because not everything is as it seems.

Okay back to my girlfriend. Well, she has a PCP (primary care physician), who gave her a referral to a specialist. Well, it appears that she was NOT told the HMO guidelines DID NOT cover that type of care. So here it is months and months later (and I do mean months) that she gets this whopping ass bill from the health care provider.

Now when she tries to get in contact with her PCP, well it appears he is no longer her PCP. She has been dished off to someone else in the HMO Coverage area. She was never notified. I know cause this girl is so organized, she alphabitizes the rice grains in the daggone box.

Then she learns that they (her company) changed from Aetna to Kaiser. So she starts gathering facts(like she is the lawyer in TO KILL A MOCKINGBIRD) to take to the benefits office in her job, when she gets a call from Kaiser who tells her that they sent the "wrong" paperwork to the billing office. So that should of settled it right? Nope! Now she has to fill out "more paperwork" to get that corrected. In the "meantime" can she just PAY THE BILL and the money will be REFUNDED after they get her paperwork.

....and you wonder why I don't give a bleep about HMO's.


Regina said...

HMO's are sickening! I had HMO issues in the past and it was a hassle, even though an HMO is better than no coverage at all... but just slightly.
I also had one of those flexible spending accounts...yea in the very, very, fine print it says if you don't use all the money by the end of the year you loose it!! Found that out the hard way...

Farmhouse Kitchen Sinks said...

HMO are sickening

deep7up said...

hahahahaha...that cartoon is fab! :D

Christine said...

All health insurers are difficult. Trying to get a billing issue straightened out is stepping into such a messy bureaucracy.