Michael Moore's Latest Target: Your HMO

[Schneed10]

Originally Posted by dmek25

all i know is that my brother in law went years never going to the doctor, never using any of his insurance " benefits". now, he gets very sick, to the point he undergoes a heart transplant. my sister and their family and now thousands in the hole, money owed to doctors because of squabbling over what gets paid, and what they owe. i might not have my facts in order, but i can still see whats right and whats wrong

This is where things get personal, and I'm absolutely not going to take it there, only to say that a good portion of the problem stems from people not understanding the coverage provided by their healthcare plans. Many HMOs won't cover the most expensive procedures, and that's spelled out in their plan literature.

I certainly get that it feels "wrong." But the blame lies with the healthcare system in general, not with the HMO. The HMO is simply trying to operate within the flawed system. If the HMO paid the claim for the heart transplant procedure, they'd either have to charge a higher premium (one resembling a PPO's premium, which defeats the whole purpose of your bro having the HMO in the first place) or they'd go out of business.

It feels "wrong" because the fundamental belief at work here is that healthcare is a "right" as opposed to a "privelege." But the HMO isn't trying to deny someone their "right." They're simply trying to pay the bills. And no, their profit margins are not very high, just take a look at the trend in their stock prices.