February 2000
NNot only as a senior, but also as the Health Benefits Representative for Branch 56, I have been watching the way health care for seniors has deteriorated over the last few years.
I think the worst thing that happens is when medical treatments are labeled “experimental.” The whole idea behind this is to keep the claim tied up long enough for the patient’s condition to get worse and then the doctor will not be able to perform surgery. It seems like some health care organizations even try to limit hospital admissions and even deny referral to specialists.
I do not find any of this is true with the FEHBP plans. I think that overall, we are well taken care of as participants in our Federal health plans. I am sure some of you out there could relate to me a horror story. But upon investigation, I would bet that there were some extenuating circumstances which preceded the problem.
In my book, HMOs have created their own definition of “medical necessity,” and it certainly seems to me to be a very narrow definition. Managed care was set up to lower prices and make care accessible to all. But, when you look at it, you would almost think that doctors and hospitals are paid by the amount of patients seen and not necessarily the care given. Did you know that these outside insurance companies, even though they try to play doctor, cannot be held responsible for their actions.
Even though Congress, in 1974, passed what is known as the Employee Retirement Income Security Act (ERISA), which also covers employer-provided health care benefits, the insurance companies routinely succeed in transferring most health insurance lawsuits to Federal court, where they escape liability for wrongful death or injury.
Those of you active members out there should keep this in mind next Open Season. Stop to think that if you are a member of an HMO, should you be out of the area that your particular HMO serves, and you have an emergency, you may have to pay for that out of your own pocket. As we retirees who are members of an FEHBP plan, this does not happen. If there is an emergency anywhere we are covered under most FEHBP plans.
