(These limitations of patients' rights are common to most managed care plans.)

1. It restricts your choice of doctors and sometimes hospitals.

2. To be one of its doctors, the physician becomes ``capitated,'' or salaried by the insurance company, depending on how many people sign up to go under his care. You and your illness now become, in effect, a liability to your doctor. Your sickness becomes his expense.

3. Your doctor is rewarded by an end-of-year bonus, for how much he or she saves the insurance company. Referrals to specialists and lab studies comes out of your doctor's own income.

4. If your doctor spends too much on your care, he or she may be dropped from the list at ANY TIME. This is called being ``deselected.'' The HMO does not have to give a reason.

5. Limited appeal: Your doctor can only appeal to the insurance company. He or she is denied an impartial third-party arbiter.

6. GAG RULE: Any criticism of the plan by one of the doctors may result in deselection (a feature of some contracts).

7. Restricted and cumbersome specialty referrals: The plan requires that the primary doctor receive approval from the insurance company before making referrals to specialists. This is a very time-consuming and costly process that must be paid for by the doctor. He might be tempted to forgo your referral.

8. The plan discourages out-of-network (unbiased) care by setting high extra fees to be paid by you.

9. The cost of the system is hidden. Actual premium costs may not be available to the patient. Instead, there is emphasis on the low office co-payment. Try asking your employer how much he pays for your care.

10. Encouragement of ``vertically integrated care'': Every ``provider,'' from the hospital to the pharmacist to the physician, benefits financially when care is limited. Those who refuse to cooperate, for moral reasons, will be excluded from the plan.

List prepared by Drs. John and Alieta Eck, Affordable Health, Inc., Somerset, NJ, (908)562- 0033.