Perspective               

Getting Information from Your HMO

Studies show that people on Medicare get most of their information about HMOs from marketing materials that show healthy people smiling and exercising. While good health and exercise are important, people need to be more concerned about how the HMOs treat people with serious health care needs. Getting this important information from HMOs can be difficult, if not impossible.

Some states, including New York, Arizona, Georgia, Maine, Rhode Island, Vermont, and Washington, have passed laws requiring HMOs to provide anyone who asks with information about the kinds of care they provide. In New York State, for example, if your HMO refuses to answer questions about which medicine or procedure it pays for, then your HMO is breaking the law.

A new study by the New York City Public Advocate’s office reports that most HMOs in the New York City area are breaking the law and do not give consumers the information they are legally entitled to. The majority of HMOs do not give callers the information they need about the care they provide. Frequently, different callers to the same HMO receive different answers to the same question. In short, even with New York’s new Managed Care Bill of Rights, people can not make educated decisions about which HMO to join.

Before you join an HMO, make sure your information is from a source you can trust. The best information is objective data, which is hard to come by. You should also speak with your doctor. And speak with family and friends who have experience with the HMO. Finally, ask the HMO directly how it will meet your specific health care needs. Without good information, it is impossible to make a good health care choice.

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