12 Questions for HMO's

If your thinking of joining an HMO, or of changing from one to another ask the HMO to answer these 12 questions. If they do not answer, or if you do not like the answer, DON'T JOIN IT.

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 test 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 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 the 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 can be dangerously inadequate.

8.  Will I be required to take medication for my condition (depression, etc...) to ensure mental health benefits will be approved?

9.  Tell me how you decide when I get to see a specialist.

10. If I refuse a psychological evaluation, will outpatient sessions be interrupted?

11. 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.

12. 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.