lrm@drutx.UUCP (MerlettoL) (08/31/85)
I recently applied for membership in the Kaiser Foundation Heath Plan of
Colorado (an HMO). I currently don't have insurance, and since I'm
rarely if ever sick I thought I'd go with the cheapest coverage.
Well, I was turned down. The rejection letter said "Medical Reasons -
Decision Final". Since then I have called and written, trying to find
out what is wrong with me (not what is terribly wrong - just what's
wrong). They tell me that there is no Federal or State HMO laws that
require their physicians to release their medical reasons for
rejection.
I'm 30 years old, I'm underweight (according to the doctor's
charts), I have low-normal blood pressure, I have never been
hospitalized, and the only illnesses I have ever had were "typical"
(like the measles, mumps, flu). I can't even make a good guess at what
medications I can't take, I haven't taken very many. The only
problem I have is I am accident prone. But, even that has much abated
since I grew out of my "tomboy" youth (and accidents usually don't have
the ongoing medical expenses of illnesses).
So, my questions are: How can an organization refuse to give me
information that can affect my medical record forever (if another
insurance co. asks if I were ever turned down?!?)? Do I have any
recourse? Shouldn't laws ensure that I have a right to that kind of
information? Any comments are eagerly welcomed!
lynette merletto
- aka mouser -
ihnp4!drutx!lrm notes@harpo.UUCP (09/04/85)
I talked to a doctor at a party. He was dead set against HMOs. His claim was that they ony took in healthly people and the primary motive was to keep costs low so the compnay could make a profit. If he joined, he would have received about $10/ visit. Also if he had to refer the patient to another doctor, the fee for the second doctor had to be paid by the first, not the HMO. Also at the same party there was a doctor in charge of an individual group practice HMO. It sounded like that operation was more concerned about quality care however your choice of doctors is limited to that group.