HMOs encourage consumers by promoting their preventative services. Since the HMO has the patient's money up front, it is important for them to keep the patient healthy. (Sinclair Community College-1999) An HMO can be described as what seemed like a good idea at the time, but quickly became a concept out of control thanks to medical bureaucracy and just plain greed. .
Physicians have also begun speaking out against HMOs in increasing numbers. The main problem with HMOs is that there are no economic incentives to take care of people. The incentive is not to do anything. (More Trouble With Managed Care PG) The federal government's attempts at reform have only added fuel to the fire. The bottom line is that people are receiving less health care instead of more "hospital stays and specialist referrals are kept at a minimum to defray costs (Evans). It is important to understand that first and foremost, an HMO is not a public service organization. HMOs are in the business to make money. The more people they can enroll, the greater the profit. When employers go shopping for a health care alternative for their employees, they are often unaware that they may become the victims of a slick marketing campaign on the part of the HMO. As we all know, if it sounds too good to be true, it is not true. The language in HMO plans is purposely ambiguous and is intentionally subject to broad interpretation. HMO flyers frequently mention unlimited hospital stays but do not clearly define what these stays are for. .
MEDICAL NECESSITY .
What may constitute a medical necessity for the patient may not for the HMO. Because the HMO is the provider and paying the medical bill, it is responsible for making a determination as to medical necessity, not the patient or his physician. The patient is primarily concerned with his or her medical condition, whereas the HMOs main focus is the costs which will be incurred in treating this ailment.