Received: from B.GP.CS.CMU.EDU by K.CS.CMU.EDU; 12 Jan 87 13:44:35 EST
Date: Monday, 12 January 1987 13:21:20 EST
From: Ralf.Brown@b.gp.cs.cmu.edu
To: bovik@k.cs.cmu.edu
Subject: More Health America discussion
Message-ID: <1987.1.12.18.20.10.Ralf.Brown@b.gp.cs.cmu.edu>

12-Jan-87 09:53    Barbara.Stone                Health America - LONG post
From: Barbara.Stone@gauss.ECE.CMU.EDU
Sorry this post is so long - I just couldn't find a way to shorten it
and still make my point and I don't know how to set pointers to a file
that everyone can access.

GENERAL COMMENTS ABOUT HEALTH AMERICA:

Being (probably) one of Health America's largest users this year
(read: most expensive: to the tune of about a quarter of a million
dollars this year - now you know why the premiums are going up),
I thought I would add my own two cent's worth concerning the
advisability of joining Health America.  Several months ago when
someone asked me my opinion of Health America, my response was
"avoid them like the plague".  Now, however, I have reconsidered
my response somewhat:


In general:

IF  *YOU* are very committed to being responsible for your
    health care and for the quality of the care provided you (i.e. you
    are aggressive, ask questions, insist on answers, check on the
    qualifications and attitutudes of the physicians and/or specialists
    [you *DO* get to choose your physician and I'm a very firm believer
    in getting one that you relate well to and who is willing to
    both listen and talk to you - it's up to you however to take the
    time to find the doctor you like and not just wait until you're
    sick and then take whoever you can get.]).  One thing that *I*
    personally have not had any problems with is Health America
    physicians neglecting to order tests, etc. - during both of
    my pregnancies, I had MULTIPLE (necessary) sonagrams performed -
    something that many obstreticians don't do (many reasons: they don't
    have the equipment & technicians in their offices [HA does] or they
    can't justify the cause to Blue Cross/Blue Shield)  I must admit
    though that the physicians in the PON are MUCH freer with Health
    America's money than the physicians in the Oakland Center.

AND you follow Health America's rules regarding emergencies, seeing
    specialists, etc. (usually simple, just time consuming and
    occasionally frustrating) 

BUT are also willing to argue with them over what you think is right
    (right not only as in that they are supposed to pay but that they
    are supposed to provide you with QUALITY health care) then I've
    found that they back down rather quickly.  For me it took a threat
    of a visit from our attorney but ours is an extreme case.
    I've found that if I call them up and am polite but very firm
    they usually don't give me a lot of trouble...of course, my name
    is probably well known down there any more!  Takeo is right
    in that if you write and provide them the info they need,
    then the bills will be paid much quicker.

THEN you can probably join Health America and be satisfied.

OTHERWISE you should probably consider an alternative health care program.

ALSO:  Personally, you couldn't pay me enough to join and visit their
    Oakland Center.  We did belong there for about a year and a half
    and I truly was NOT satisfied with the physicians (internal medicine,
    ob/gyn or pediatricians).  Their attitudes AND general ability
    left, in my opinion, quite a bit to be desired.   We now belong
    to their PON (Physicians Office Network) and I love it.


In the event that anyone doubts how much we've used them, consider the
fact that we have a nine month old son who was born with non-functioning
kidneys.  The physicians in Pittsburgh, supposedly some of the best
transplant people, gave him absolutely no hope of survival.  They would
not even put him on dialysis and try to save him.  Fortunately, we
found a nephrologist in Texas who took over his care, put him on
dialysis, and, a couple of months ago, organized his transplant.
He now has a new kidney, is continuing to develop normally (contrary
to what the physicians at Children's told us was going to happen),
and is as happy and healthy as can be.  Health America did try to
get out of paying and then even tried forcing us to go back to
Children's Hospital but we were just very aggressive, very determined,
and wouldn't back down.  They did end up paying even though the
physician and hospital were in Houston, Texas, quite a ways outside of
Health America's normal treatment area and not their usual consultants.
So far, bills for my son this year have cost Health America
well in excess of a quarter of a million dollars (we estimate that
once all the bills are in that figure will probably double)
but they are paying...I didn't say they like it...but they ARE paying.
(and we received copies of all the bills along with a few nasty notices but
I guess I don't have the time to let that upset me - sooner or later
the people sending the notices will get their money - from Health
America, by the way, not me - and in the meantime all they're trying
to do is intimidate you so you'll pay and they won't have to harass
the insurance company - Health America isn't stupid - if you'll pay,
then they've just saved that much money)

Health America tried very hard to get out of paying originally and I
have to admit that the stress of fighting with them along with the stress 
of trying to cope with my son's health problems often made me wish I had Blue
Cross/Blue Shield, but the thought of owing 20% of the total bill for
my son's medical expenses makes me shiver now though.  

REMEMBER:  Health America is a business and has its good points and bad points
    just like anything else.  I personally have had just as much trouble
    getting Blue Cross to agree to pay anything.  We also live outside
    of the city and don't find the other HMO's feasible so I can't give
    you much of a rundown on them.



Please don't send mail complaining that this post belonged on opinion
or was too long - I did try to warn everybody.


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