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Health Care Reform:

Health Insurance & Affordable Care Act

Supreme Court Ruling Narrows Suits Against HMOs


Greene and several friends developed an intestinal illness after eating a fresh-raspberry dessert at Greene's bachelorette party. Greene's HMO doctor diagnosed her over the phone with stomach flu. But she contacted her local health department, got tested, and was diagnosed with cyclospora. Armed with that information, she went back to her doctor and got the antibiotics she needed to treat her illness.

Greene, who has since switched to a PPO plan, has these suggestions for people trying to resolve conflicts with a health plan:

  • Find out exactly who makes the decisions for your care; it's usually the insurer or the medical group that is contracted to give care. Call them and push for what you need.
  • If your coverage is provided through your job, consult the human resources department for help. As representatives of your employer, they have more clout because they help decide which insurer to use.
  • Ask a human resources representative for shortcuts. They may know the name of someone you can call directly to discuss the problem, so you don't waste time being transferred from person to person.

Many medical centers and some managed-care organizations have patient advocates who can also assist patients and their family members in getting the care that they need, and getting providers who are able and willing to provide that care.

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