Political Quotes

“last week there was a newspaper article that highlighted one of the fundamental issues at the center of the HMO debate: Who decides medical necessity, an insurance company or our local doctors? A doctor was treating a pregnant woman who had obstetric coverage and needed a shot to protect her unborn baby from the chicken pox virus. Despite the fact that this shot is routine in this situation, and the fact that her insurance coverage also covered obstetrical care, her HMO refused to pay for that shot. The response by the American Association of Health Care Plans was that the decision to deny care was probably based on the fact that the service was not covered by that woman's health plan. Now it seems it is not enough simply to purchase a health insurance that covers obstetric care, but HMOs expect every employer in our country to make sure that every foreseeable problem or treatment is specifically covered. Obviously, that would be impossible, and it is ridiculous to even suggest that. If our insurance plan covers a medical condition, our doctor should be able to decide how to treat us for that particular medical condition. The right of doctors to determine medical necessity is one of the key issues that has been included in the HMO reform bill that is predominantly Democrat-supported.”