Managed Care: How One Big HMO Capitulated

Ask almost anyone what's wrong with HMOs these days, and the answer is often the same: precertification. Before ordering tests for colon cancer or even scheduling surgery, many doctors must submit their therapies and plans to company reviewers. Examples of denied care have produced the worst horror stories associated with managed care. The process has left doctors frustrated and patients anxious. It also fueled a revolt in Congress last month in which a band of rebel Republicans rolled over the House leadership to pass a bill giving patients the right to sue their insurance companies for the medical decisions they make.


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