OnlineHost:  Dr. Alan J. Steinberg has entered the room. 
 
Dearest:	Health maintenance organizations, better known 
as HMOs, are rapidly becoming the predominant form of health 
care in this country. What with 74 million people having HMOs
as their form of health insurance at the end of 1997, experts predict
that number will double by the year 2002.

There is a great deal of confusion surrounding HMOs and their profit
driven policies. My guest in Power Surge tonight . . .

D R.  A L A N   J.  S T E I N B E R G ...

... arms us with knowledge in his timely and groundbreaking book,

"The Insider's Guide To HMOs: How To Navigate The Managed-Care System 
and Get the Health Care You Deserve" (Plume, 1997).  

Dr. Steinberg shows us that it's possible to make the HMO system
work for us. "The Insider's Guide To HMOs" provides the crucial
information we all need to make better informed decisions about
health care.

Dr.  Steinberg is a doctor-partner in a small managed-care company
in Marina Del Rey, CA, and was previously affiliated with Kaiser
Permanente, the largest HMO organization in the country.

Utilizing case studies from years of experience and hundreds
of interviews with doctors and patients, Dr. Steinberg illustrates
the basic concept about HMO's and a behind-the-scenes view of
how medicine is practiced and how medical decisions are made.
He provides many specific suggestions about obtaining the
best possible health care from 	our HMOs.

Dr. Steinberg, a very warm welcome to Power Surge. Perhaps
it would be best to begin by defining exactly what an HMO is and how 
it works. Thank you :)   


Dr. Alan J. Steinberg:	An HMO is a form of health insurance 
that includes the insurance company and the providers.


Dearest:	Dr. Steinberg, you talk about three main types of 
HMOs -- the staff model,  group model and IPA model. What are they
and how do they work?


Dr. Alan J. Steinberg:	The Staff model HMO has the physicians 
as employees.


Dearest:	And the Group Model?


Dr. Alan J. Steinberg:	The Group model is where the doctors 
are in groups and contract with different HMOs. 


Dearest:    .. and the IPA model?  :)


Dr. Alan J. Steinberg:	The IPA model is where private practice 
physicians join together to form an IPA which then
Contracts with various HMOs.


Dearest:	Thanks, Dr. Steinberg...  VB, go ahead.


VBrando101:	What is the difference between a PPO 
and an HMO? 


Dr. Alan J. Steinberg:	A PPO usually pays the health care 
providers (doctors) a fee for service, but an HMO 
usually is much more tightly controlled; the doctors in 
an HMO usually share risk of the cost of the medical 
care they provide.


VBrando101:	Thanks 



Joan5000:	True that Congress has passed a ruling,
allowing no private health care for people over 62? 


Dr. Alan J. Steinberg:	I think you've misunderstood the recent 
news articles.


Joan5000:   What is the answer on paying who you want?


Dr. Alan J. Steinberg:	In an HMO or a PPO there are very 
specific rules on who can be paid .


Dearest:	Joan, does that answer your question?


Joan5000:	Not really, sorry


Dearest:	Can you elaborate, Joan?


Joan5000:   If your doctor is not on the list, and you 
pay, why can't you use this doctor?


Dr. Alan J. Steinberg:	You can always pay to see a doctor
who is not on the list It is that the discounts the PPO 
or the HMO will give you wont be given to you if the 
doctor's not on the list.


Joan5000:  Thank you 


Dearest:	Dr. Steinberg, why do all the good 
doctors at my HMO leave?  


Dr. Alan J. Steinberg:	HMO's often require that their doctors
participate in an


Dearest:	Thanks.  Blush, go ahead.


Blush:	Wouldn't BC pills accomplish the same
thing as abortion... no additional dependents on the 
policy?  Would there be any other reason?


Dr. Alan J. Steinberg:	Sorry, it is a long answer, but there is 
a difference financially.  I'd have to think about it more 
to give you the differences succinctly.


Blush:	Thanks anyway.. I understand.


Dearest:	(Blush, you might want to E-Mail 
your question to Dr. S. later)


Dearest:	Windock, go ahead, please.


WINDOCK1:	What happens when one retires & 
moves outside the HMO area? 


Dr. Alan J. Steinberg:	You need to get a new HMO and a 
new set of doctors .


Catalina5:	How can we find out how docs are 
paid in our HMO?


Dr. Alan J. Steinberg:	You need to ask the HMO or the 
doctor;  don't be shy; this is a very important question.


Dearest:	What if you're not satisfied with the 
care you're getting in your HMO?  What is your
recourse? 


Dr. Alan J. Steinberg:	You can complain; if you are the type 
of patient that has expensive medical problems, many 
HMOs would be happy for you to leave.


Dearest:	Thank you. Red, go ahead :)


Redfencer:	Are the Dr.'s in HMO's members of 
AMA, Board Certified, etc.?



Dr. Alan J. Steinberg:	Most are board-certified, some are 
members of the AMA.  They are just like most doctors 
except they work for an HMO.


Kaaitjie:	Why do you think that Kaiser agreed to
pay for some alternative therapies, such as acupuncture.  
What are chances for other HMOs to do same?


Dr. Alan J. Steinberg:	Kaiser is trying to keep their image up; 
alternative therapies are currently quite fashionable.


CAJASS:	My doctor accepts my HMO and other 
ins co. Isn't this very different than being part of HMO 
FACILITY so to speak?


Dr. Alan J. Steinberg:	No, your doctor may be paid by your 
HMO by capitation; under capitation your doctor does 
not want to see you, financially speaking.


LLMPDR:	Will HMO's refer you to a facility out of 
state if the care is needed?


Dr. Alan J. Steinberg:	HMOs often err on the side of doing 
consultations "in house"; it is much less expensive for 
them to do it this way.


LLMPDR:	What if you need surgery?


Dr. Alan J. Steinberg:	Good Luck!  Most HMOs prefer not to 
do surgery if they can get away with it; it costs less, 
sometimes, not to do surgery.


Dearest:	Dr. Steinberg, you know the more you 
say about HMOs, the scarier it sounds. And this is our future (sigh)


Dr. Alan J. Steinberg:	HMOs should scare you!  They scare me.  
That's why I wrote my book.  


Dearest:	Whew! CAJ, go ahead.


CAJASS:	Can you explain what you mean by capitation? 


Dr. Alan J. Steinberg:	Capitation is when a doctor is paid a 
fixed amount of money per patient signed up with her 
whether the patient is seen or not!  If the patient never 
comes to the office, the doctor makes a lot of money 
for no work; if the patient comes in a lot to the office 
the doctor makes the same amount of money; under 
this system, the doctor, financially speaking would 
rather not see their capitated patients.


CAJASS:	Thanks I get it now.


LLMPDR:	The question again is whether you think 
doctors will give as good a care in a crisis?


Dr. Alan J. Steinberg:	In a crisis, most doctors, HMO or not, 
will try to give the best care; but money clouds doctors, 
and everyone's judgment,  you dont want your doctors 
judgment clouded in a negative way by your HMO.


PAVinson:	Regarding previous question on retirement 
and moving to another state, will pre-existing condition be 
a factor with the new HMO? 


Dr. Alan J. Steinberg:	HMOs are insurance companies; they will 
try to exclude anyone who might cost them extra money.


PAVinson:	I thought there was a law passed recently 
concerning pre-existing conditions.


Dr. Alan J. Steinberg:	The law is very vague and applies very 
rarely; it is still a dangerous world out there; dont expect 
laws to always protect you.


PAVinson:	Ok, thanks


MsLizzieB:	So is it your position that you get better 
care if you go private and pay whatever it costs?


Dr. Alan J. Steinberg:	It is my position that you will always get 
better care when you pay your doctor fee-for-service.  
HMOs usually pay their doctors via capitation
or by salary.  


Dearest:	I keep thinking of doctors getting decapitated :(
		No wonder they don't want to stay :(


Dr. Alan J. Steinberg:	If you cross the HMO, they may try to 
decapitate the doctor.


EPiontek:	lol dearest



CAJASS:	Do all HMO's pay by capitation?


Dr. Alan J. Steinberg:	Not all do, but most are moving in that 
direction; it is their goal.


TidBits96:	How can we protect our aging (and 
obviously undesireable-insurance wise-) selves from what
is a very ominous future.


Dr. Alan J. Steinberg:	Make sure that fee-for-service Medicare 
is not decapitated by President Clinton.


BEATLES2nd:	How do feel about socialized medicine?


Dr. Alan J. Steinberg:	HMOs are a small form of Socialized
medicine.  Socialized medicine is fine as long as I have 
a choice not to participate.


Dearest:	Dr. S., is your current practice an HMO?  


Dr. Alan J. Steinberg:	About half my patients are in an HMO 
and half are in private practice.


Dearest:	Thanks.... CAJ, go ahead.


CAJASS:	I am truly happy with my doctor and my 
HMO.  I have never been denied  any care and believe 
me my family is not making them any money.


Dr. Alan J. Steinberg:	Most patients are happy with their HMO 
doctor, but if you get a chronic, expensive medical 
problem, please let me know how happy you are then.



Kaaitjie:	I've heard it all from the physician's side - 
my brother is in CA - he gets  paid $20 for a surgical 
procedure - and he is having a tough time believe it or not.


Dr. Alan J. Steinberg:	Many doctors are having a tough time 
under HMOs, when doctors have a tough time, 
eventually their patients will feel it.


Kaaitjie:	Hear Hear!!


CAJASS:	I have been thru this with my HMO.  
They paid $1000 a month for injectibles for my daughter
and never had problem - still ongoing with her also.


Dearest:	I go to my private physician (of over 20
years) for anything serious and if he recommends tests, 
I go to the HMO.


Dr. Alan J. Steinberg:	You should not be thrilled and surprised 
when a HMO does what does what it supposed to do; 
the real question is, will it always do the right thing if you
really need them?  


Dearest:	Is there anything we can do to improve 
the current situation with HMOs? Like not getting sick?  :)


EPiontek:	(lol dearest)


Dr. Alan J. Steinberg:	You need to educate yourselves, 
demand the best care from your HMO, read my book!, 
and make sure you dont let your HMO get away with 
anything!  


Dearest:	Right on!


BEATLES2nd:	And if you can't afford the best 
care you should just roll over and die.


Dearest:	 Beatles, ( g ) What type of doctor are you, 
Dr. Steinberg? 


Dr. Alan J. Steinberg:	I am a board-certified Internist.


PAVinson:	I am a case in point who is totally 
satisfied with HMO-- dx with breast cancer in 
February, had surgery, rad treatments, and have had 
nothing but the best of care!!!!  Guess I am one of 
the lucky ones!!!!!!!!


Dearest:	Thank God, PAV.


PAVinson:	Yes Dearest


Dr. Alan J. Steinberg:	There are many lucky patients in 
HMOs, but you shouldn't have to be lucky.  You 
should know that when the chips are down your 
HMO will be there for you.


Dearest:	Dr. Steinberg, thanks ever so much for spending 
this time in Power Surge... answering our questions about HMOs. 
You've been a wonderful guest, and we hope you return to 
Power Surge very soon.

You can buy Dr. Steinberg's groundbreaking on the Net at amazon.com --  

"The Insider's Guide To HMOs: How To Navigate The Managed-Care System 
and Get the Health Care You Deserve" (Plume, 1997).  
 

Dr. Alan J. Steinberg:	My Pleasure 


Dearest:	Dr. Steinberg, can I ask you one unrelated question?


Dr. Alan J. Steinberg:	Sure  


Dearest:	Do you treat any menopausal women?


Dr. Alan J. Steinberg:	All of the time  


PAVinson:	He's got a roomful here, Dearest!!!!!!!!!
SGETT:	        Here comes the smoking gun!!!!!!!!

Dearest:	Why do you suppose so many doctors are so 
unenlightened about menopause?


LORACURA:	Ask about HRT
Redfencer:	because they don't have to go 
        		through it D!
Redfencer:	..if it were prostate...that would
        		be another thing!


Dr. Alan J. Steinberg:	HRT is a very good therapy for many 
women, but not for everyone. I believe many women do quite well 
with progesterone cream and other non-traditional therapies.


LORACURA:	hooray


Dearest:	With the OTC progesterone creams, Dr. S.,
or the prescription ones that are a bit stronger?  


Dr. Alan J. Steinberg:	I dont think there is much difference 
other than the cost  


Dearest:	Thank you, Dr. Steinberg.. You're a good sport :) 
Thanks for visiting us in Power Surge, Dr. S. You're welcome back any time :)


Dr. Alan J. Steinberg:	I'm going to sign off the kids want to 
		use the computer  


Dearest:	Night.. and take care :)


Dr. Alan J. Steinberg:	Thanks!!!!!  



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