Re: Harry & Louise Part II

[Whistle <weeethistle@yahoo.com>]

Dear Al and Peter and all --

Have you heard of a "Care Manager" for services such
as mental health outside of HMO plans?  Evidently the
Care Manager has left the umbrella of the HMO and
moved into all health insurance policies available in
NJ.  In NJ the insurance industry has segregated out
mental or emotional illness from physical illness and
has made it mandatory that a patient's physician can
no longer make decisions about the care of their
patient.   "Care Manager manages, assesses,
coordinates, directs and authorizes a Covered Person's
Treatment..."and Horizon will provide Network level of
benefits when treatment is "Medically Necessary and
Appropriate -- not as recommended by the physician but
by the Care Manager whoever that person is.  There is
no explanation offered as to the education,
qualifications and experience of the Care Manager.  I
am not sure what "parity" means in New Jersey but it
obviously does not extend to the patient's right to
equal treatement by a physician.  

I checked with my benefit negotiator and he said that
this "RIDER" is now part of every policy written in
the State of New Jersey, for all insurance companies
and is not limited to HMO companies.

I find this alarming because obviously we want
physicians to be the people we turn to when we are
sick or need medical help.  It is extremely arrogant
to expect consumers to talk on the telephone to an
unknown person about their most personal problems not
knowing anything about the person on the other end of
the telephone -- it requires that we give up our
privacy and confidence to strangers.  If we refuse to
go along with this, we will not get insurance benefits
for this sort of care.

Is this happening in all states in this country? 

Whistle
> Peter-
> 
> What this boils down to is this: back in 1996, AAHP
> published a book titled 
> "Changing HealthCare" by AAHP and Ken Jennings, PhD.
> It was a rosy-scenario 
> obvious sell-out of a book, glorifying the claims
> and "benefits" of MCO's, 
> mangled, oops, I mean, managed care, and HMO's. 
> 
> To make a 300 page book short, it essentially said
> that managed care 
> corporations will (right around the corner), once
> they are given a shot, not 
> only CARE for their patients, they will "anticipate
> the needs" of mco/hmo 
> patients, and have the exact care READY for the
> patient before the patient 
> even is aware of the need for the care. BALONEY. 
> 
> Not only is this PURE balderdash and absolote horse
> hooey, there is not one 
> word in the book, for obvious reasons, about THE
> REALITY OF HMO's: the 
> systematic DENIAL of care, fudging (i.e. losing)
> specialist referrals, 
> systemic denials of procedures based on some
> undeducated clerk's claim of 
> "lack of medical necessity", obfuscations, escape in
> any and every form of 
> responsibility, and decline of care endemic to
> managed care systems... In 
> other words, this book is a pure PR dreamwork. It
> has NO basis in reality, 
> and the real joke is, if you have ever been part of
> a managed care operation 
> (I have been member of two of the *biggest and
> best*), THE REALITY is a far 
> cry from the miraculous and glorious claims of this
> cheerleader type 
> falsehood. It is an assault on modern medicine, and
> an insult to patients. 
> Granted, it is a cash cow for executives. 
> 
> The fact that these guys and their minions, such as
> AAHP, will go to ANY 
> extent necessary to AVOID trial by jury only
> reinforces the perception that 
> their *way of excellence* cannot hold up to ANY kind
> of scrutiny. If they 
> have nothing to hide, no problems in need of
> sweeping under the rug, so to 
> speak, then why the relentless, tenacious fight to
> keep themselves, and their 
> patient *care* out of the courtroom, and away from
> juries??? Why? Because 
> juries would find them liable to an extent that
> would make the tobacco cases 
> look like Barney episodes. They would lose left and
> right, and they KNOW it. 
> THEY CANNOT AFFORD the scrutiny of a trial, because
> a fair, close glimpse 
> would reveal their modern miracle as a mirage of the
> worst, and cruelest 
> kind. 
> 
> Al
> 
> << 
>  In a message dated 8/23/99 7:50:21 PM EST,
> techdiff@ix.netcom.com writes:
>  
>  <<  America's trial lawyers - in support of
> legislation they're calling `The
>   > Patients Bill of Rights.' But what it really
> does is give government
>   > bureaucrats the freedom to create more
> regulations and more red tape - and
>   > give trial lawyers more opportunities to cash in
> on all kinds of frivolous
>   > lawsuits."  The ads then name the local House
> member they are targeting, 
>  and
>   > ask listeners to call to voice their opposition.
>   > 
>   > Kahn said health plans and business groups
> opposing managed care bills 
> will
>   > spend more than $1 million "working toward a
> cacophony" of criticism of 
> the
>   > bills. There will be TV advertising and "heavy
> radio" during the last two
>   > weeks of the congressional break >>
>   >>
> 

===
Thistle
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