Home » Mind & Soul » Mental Health Advocacy » Victory Against the Almighty HMO

Victory Against the Almighty HMO

© Jennifer Miller

The latest developments in the ongoing battles between patients and Health Maintenance Organizations (HMOs) have finally shown the favor turning towards the patients. With legislative bills being passed at both state and federal levels, a new era in patient care may not be far away.

HMOs have recently been thought of as an inherent evil within the medical community. Most HMOs are seeking to follow the practice of "Managed Care", which concentrates on cost cutting over patient well being. Due to the relatively low cost of HMO premiums, enrollment has jumped more than 90% since 1985. Most employers offer an HMO to their employees, and most people cannot afford private health insurance.

Mental health in particular has borne the brunt of the sometimes cruel cost-cutting "treatments" HMOs have prescribed and implemented. Mental illness is rarely fully covered by HMOs, if at all. Most mental health concerns are limited to only 20 doctor visits per year, and the co-payments for such visits are often higher. Many patients are denied necessary treatment by their HMOs, due once again to cost cutting.

New bills that have been recently passed in the senate on both federal and state levels are seeking to change the way HMOs treat their patients. In California, Gov. Gray Davis just signed a package of health care bills that will allow patients to obtain the care they need. The new laws will let consumers sue their HMO if they are harmed by the insurer's decision to delay, deny, or alter necessary treatment. The new laws will also require insurance to pay for a second opinion when the patient requests it, and it will force HMOs to cover contraceptives, cancer screening, and treatment of diabetes and mental illness. Most importantly, it forces HMOs to have the SAME EXACT coverage for mental illness as it does for other illnesses. This means no more limits or "caps" on how many therapy sessions a mentally ill patient can receive. It also means that treatment for mental illness can't have higher co-pays than other treatments covered by the plan.

"California now leads the nation in HMO reform," said Melinda Paras, executive director of Health Access California, a coalition of groups fighting for health care change. "Gray Davis deserves credit for being the first governor to listen to the will of the overwhelming majority of Californians on this issue."

On a national level, the House of Representatives passed new healthcare reform packages that also allows consumers to sue their HMO. The new bills also guarantee that patients will have access to specialists, ensure that important medical decisions are made by your doctor and not a utilization review board, and also assign appeal panels that are independent of the HMO.