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Phone: (800) 635-1196
Hotline: (800) 419-4777
of American Physicians and Surgeons, Inc.
A Voice for Private Physicians Since 1943
Omnia pro aegroto
HOW TO RECOGNIZE A COERCIVE AND RESTRICTIVE HEALTH
(These limitations of patients' rights are common to most managed care plans.)
Such a system is NOT INSURANCE, BUT A SYSTEM OF COERCION, which meddles in the
patient-physician relationship for profit. Any company that places its employees in such a plan
and any doctor who participates may subject the worker/patient to potential abuse.
FREEDOM IN MEDICINE IS EVERYONE'S RESPONSIBILITY. There is an alternative that
will make medical care more accessible and affordable, with complete freedom of choice:
Medical Savings Accounts combined with high-deductible insurance. For information, call
- It restricts your choice of doctors and sometimes hospitals.
- 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
- 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
- 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.
- Limited appeal: Your doctor can only appeal to the insurance company. He or she is denied
an impartial third-party arbiter.
- GAG RULE: Any criticism of the plan by one of the doctors may result in deselection (a
feature of some contracts).
- 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.
- The plan discourages out-of-network (unbiased) care by setting high extra fees to be paid by
- 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.
- 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-