RE: A Few Thoughts on HMO Coverage Problems

May 6, 2004

Hi Ladies,

I was one of those ladies that Pat talks about, that made the decision to

switch insurance coverage during my window of opportunity last year (the month

of November). The new coverage didn't go into effect until first of January,

however it was more than worth the wait. I switched from my HMO where I had

100% coverage and premiums were low, to a PPO, where I am responsible for 30 -

40% of everything and premiums are high. After the meetings with my HMO doctor

and then my " new " (or what I call " real " ) doctor, there was no question that my

husband and I weren't switching over and getting the best care I could get.

The HMO doc, of course, was emphatic that I needed a hysterectomy. No other

options presented. Luckily he went on vacation before the HMO authorization

arrived for the surgery, and by that time I was very well read. I then asked

him about a myomectomy, and he basically scoffed at the idea - tumor too large,

the risk of blood loss too great - and of course I was too old to really want my

uterus, wasn't I? I even toyed with the idea of insisting that my HMO do a myo,

but thanks to Dr. Stanley West, in one of his online chat sessions, warned me

that this would be a grave mistake for a surgeon to attempt if they did not have

the experience. So I went back to my HMO doc and asked him just how much

experience he had with myos. The only answers (they were statements, really) I

was able to get from him was that he took great pride in his surgical skills,

and hadn't " lost " any patients. I couldn't even get a number from him. Closest

I got was that he had just performed a myo with a very large fibroid...during a

hysterectomy! Well it didn't take a rocket scientist to read between his eye

balls. I politely left and ran like hell to Dr. in L.A.!!

I forfeited my savings and a planned first time trip to Hawaii, but honestly, I

have never regretted my decision in the least. I invested in my own health, had

the best care I could get by a top of the line doctor, and I have a quality of

life I haven't had in years.

I will most likely return to the HMO next year, however I will continue to keep

Dr. as my gyno, regardless of the fact that I have no coverage outside of

my HMO group.

For anyone with the same opportunity, I hope you will look into this option.

Best of luck to you.

Rhonda

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