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HMO Questions and Answers

HMO Questions & Answers

Q. What does HMO stand for?

A. 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 eye. Modern practice replaces the
physical finger poke with hi-tech equivalents such as voice mail
and referral slips, but the result remains the same.

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

Q. I just joined a new HMO. How difficult will it be to choose the doctor
I want?

A. 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.

Q. What are pre-existing conditions?
A. 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.

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

Q. 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?

A. 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.

Q. 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?

A. 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.

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