The TEN COMMANDMENTS for HMOs

  1. Tell me exactly how you reward your doctors for cost containment. I want to be sure that your system won’t keep me from having needed tests or seeing a specialist.
  2. Describe how you ensure that I will always be treated by a competent, well-trained physician with no black marks on his/her record.
  3. Let me know up front who decides what is “medically necessary” in my case.
  4. Tell me how I can appeal a medical decision that I don’t think is correct, and tell me how soon I will get your answer.
  5. Assure me that I will have free choice of physicians within your Plan. Also tell me who pays if I want to see a doctor outside your Plan.
  6. Tell me what percentage of your revenue actually goes to treat patients as compared with marketing, administration and profit.
  7. Describe how you decide what drugs to provide for your patients. I need to be sure that I can get the best drug for my particular medical problem. I have heard that generic drugs and other substitute drugs can be dangerously inadequate.
  8. Tell me how you decide when I get to see a specialist.
  9. Give me an easy way to let you know what I think about the quality of care your staff provides. Reward those who get high ratings.
  10. Describe to me how I will get prompt care in a medical emergency. Tell me whether you will charge me if I have to go outside your system.

If you’re thinking of joining an HMO, or of changing from one HMO to another, send out the “TEN COMMANDMENTS for HMOs” . Ask the HMO to respond with answers. If they don’t answer, or if you don’t like the answers, DON’T JOIN that HMO. Do the same with another HMO until you find one that answers your consumer concerns.

PLEASE COPY the “TEN COMMANDMENTS for HMOs” and DISTRIBUTE FREELY. When more people ask good questions and insist on answers, we’ll have better consumer protection for everybody.

NOTE: Colorado is pioneer in requiring health insurance companies to provide extensive information to all potential policyholders.

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