HMO Questions and Answers


1.    What does HMO stand for?
    This is actually a variation of the phrase, "Hey, Moe!" Its roots go back to a concept pioneered by Doctor Moe Howard, who discovered that a patient could be made to forget about the pain in his foot if he was poked hard enough in the eyes. Modern practice replaces the physical finger poke with hi-tech equivalents such as voice mail and referral slips, but the result remains the same.

2.    Do all diagnostic procedures require pre-certification?
    No. Only those you need.

3.    I just joined a new HMO. How difficult will it be to choose the doctor I want?
    Just slightly more difficult than choosing your parents. Your insurer will provide you with a book listing all the doctors who were participating in the plan at the time the information was gathered. These doctors basically fall into two categories -- those who are no longer accepting new patients, and those who will see you but are no longer part of the plan. But don't worry -- the remaining doctor who is still in the plan and accepting new patients has an office just a half day's drive away!

4.    What are pre-existing conditions?
    This is a phrase used by the grammatically challenged when they want to talk about existing conditions. Unfortunately, we appear to be pre-stuck with it.

5.    Well, can I get coverage for my pre-existing conditions?
    Certainly, as long as they don't require any treatment.

6.    What happens if I want to try alternative forms of medicine?
    You'll need to find alternative forms of payment.

7.    My pharmacy plan only covers generic drugs, but I need the name brand. I tried the generic medication, but it gave me a stomach ache. What should I do?
    Poke yourself in the eye.

8.    I have an 80/20 plan with a $200 deductible and a $2,000 yearly cap. My insurer reimbursed the doctor for my out-patient surgery, but I'd already paid my bill. What should I do?
    You have two choices. Your doctor can sign the reimbursement check over to you, or you can ask him to invest the money for you in one of those great offers that only doctors and dentists hear about, like windmill farms or frog hatcheries.

9.    What should I do if I get sick while traveling?
    Try sitting in a different part of the bus.

10.    No, I mean what if I'm away from home and I get sick?
    You really shouldn't do that. You'll have a hard time seeing your primary care physician. It's best to wait until you return, and then get sick.

11.    I think I need to see a specialist, but my doctor insists he can handle my problem. Can a general practitioner really perform a heart transplant right in his office?
    Hard to say, but considering that all you're risking is the $10 co-payment, there's no harm giving him a shot at it.

12.    What accounts for the largest portion of health care costs?
    Doctors trying to recoup their investment losses.

13.    Will health care be any different in the next century?
    No, but if you call right now, you might get an appointment by then.