[quote=ocrenter] . . . But Kaiser is a HMO that hire their physicians. Therefore, if there is a bad outcome, then we have “Kaiser did this to me! Kaiser is a BAD HMO.” . . . [/quote]
ocrenter, you hit upon the problem right there. I guess I should have intimated that the business model of the typical HMO (such as Kaiser) was to blame for patient-runaround.
If I want to see a particular specialist, I can just make an appt with him/her (in or out of “network”). If I am a cancer patient and want to participate in a clinical trial at the MD Anderson Cancer Center in TX or a specialized treatment program that is only being offered at the Mayo Clinic in MN, I can do that and Aetna will cooperate acc to the terms of my coverage, no problem. If the providers happen to be “out of network,” I’ll just have more co-insurance responsibility. HOWEVER, there are many thousands of Aetna providers across the nation.
I have never had an HMO (even when given a choice thru an employer, I chose the PPO or HDHP) because I don’t want to be held back from care by an HMO “gatekeeper.” It is TOTALLY WORTH IT to have a PPO or indemnity plan, even if it costs more out-of-pocket, IMO.
