THE TEN COMMANDMENTS for HMOs were born from complete frustration.

My husband (who has Alzheimer’s Disease) and I are both seniors. Convinced that Medicare and Medigap premiums are going to rise–it’s only a question of when and how much–I decided to check on alternatives. Lured by billboards, newspaper and TV ads which promised better health care at a lower cost, I contacted five HMOs that serve Medicare seniors in Jefferson County, Colorado.

The process of trying to get information was excruciating. I studied the marketing materials they sent me in glossy brochures. I tried to read and then understand the fine-print legal language in their contracts. Then I wrote and mailed to each of the five HMOs a set of important QUESTIONS that hadn’t been answered satisfactorily in their marketing materials.

Two of the five HMOs didn’t even bother to respond to my questions. The other three did respond, but some of their answers were incomplete, ambiguous or downright misleading.

They were especially misleading about the main factor that affects the quality of health care that patients get in HMOs: an incentive system that gives financial rewards to physicians who are especially stingy in ordering lab tests or in referring patients to specialists. All three HMOs claimed “NO, WE DON’T DO THAT.” But a little sleuthing revealed that “it ain’t necessarily so.” In these three Plans, either individual doctors (or groups of doctors) or the Medical Director are rewarded financially for spending less on patient care — and/or penalized if they spend more. Some Plans even fire doctors who won’t practice “Just Say No” medicine.

MY CONCLUSION: Short of using the rack or the water-drip method, I currently cannot get enough information to make a wise decision. And if that is true for my husband and me, the same must hold true for other seniors in our community. And ALSO TRUE for alot of employers who contract with HMOs to provide medical insurance for their employees. And ALSO TRUE for the employees themselves, who frequently don’t have a clue as to what is covered until they get really sick. And finally, ALSO TRUE for all the people on Medicaid, who undoubtedly will be required to join an HMO within the next few years.

Hence THE TEN COMMANDMENTS for HMOs.

MY MESSAGE: Send a copy of THE TEN COMMANDMENTS for HMOs–as well as the related QUESTIONS to ASK the HMOs –to any HMO you have already joined or are thinking of joining. Insist on answers.

Also send the COMMANDMENTS and the QUESTIONS to your representative in the State legislature, and to your U.S. congressperson and senators. Urge them to write legislation and vote for laws that require HMOs to give the public complete information about what they do and do not cover.

Knowledge is power, and today our power as consumers is dangerously limited. Insisting on complete information is FAIR, and it’s REASONABLE.

After all, it’s in the American tradition to kick the tires before we buy the car.