Bringing the Text to Life
More and more Americans are receiving medical care through HMOs: Health Maintenance Organizations. [Ask for a show of hands: How many of you are currently members of an HMO?]
People criticize these health plans for replacing the old doctor-patient relationship with a new and impersonal bureaucracy, but at the same time many patients appreciate the low out-of-pocket costs that come along with HMOs. [Another show of hands: How many are frustrated with your HMO? How many are satisfied?]
A whole new vocabulary has grown out of these systems: primary care physicians, copay, usual and customary fees, medically necessary services. These terms puzzle us, confuse us, and in some cases make us angry. For instance, patients sometimes wage war with their HMOs over what type of treatment is "medically necessary." A person might be convinced that he needs a referral to a specialist, while an HMO argues that such treatment is not required and cost-efficient. If you go to your primary care...