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Two Missourian's Tell Their HMO Stories

October 4, 1996
By: David Freitas
State Capital Bureau

Behind the issue of managed care are the people who it affects.

With HMO's becoming increasingly popular, the curiosity about whether people are satisfied with their health care is growing.

Each account that we hear from people about their HMO's is unique.

David Freitas talked with two Missourian's who have had very different experiences with their HMO's.

Story:
RunTime:
OutCue: SOC
Actuality:
RunTime: 09
OutCue:
Contents: Jefferson says that when we buy an appliance we know what we're going to get, why can't we do the same thing with health care?"

Jeanette Jefferson is a registered nurse who was so sick three years ago her doctor told her she would never walk again.

Then Jeanette did the unexpected.

Actuality:
RunTime: 20
OutCue:
Contents: Jefferson says her doctor was pleasantly surprised when she could walk after having a stroke. He wanted to get her more physical therapy, but the HMO just kept saying no."

After being a life-long member of an HMO and a health care professional, Jeanette thought she was taken care of when she retired.

But when her HMO told her she could not have any more physical therapy after her stroke, she says she got scared.

Actuality:
RunTime: 10
OutCue:
Contents: Jefferson says when doctors and nurses are in charge she get scared.

The irony is that Jeanette worked for an HMO her entire career as a nurse.

And now Jeanette says she cannot depend on her HMO anymore and has to look elsewhere for support.

Actuality:
RunTime: 15
OutCue:
Contents: Jefferson says she has her faith and family and friends.

Like most of us, Jeanette says she got her insurance through her employer and wasn't aware of the plans restrictions.

Actuality:
RunTime: 10
OutCue:
Contents: Jefferson says she did not know her doctor would not be in charge when she became ill.

HMO critics say Jeanette's situation is not unique and that many people do not know exactly what is and is not covered even if they have a copy of the contract.

Even though Jeanette had such a bad experience with her HMO, she still says managed care is not all bad.

Actuality:
RunTime: 20
OutCue:
Contents: Jefferson says there are good sides, but if the bottom line is going to be money than HMO's are bad.

Actuality:
RunTime: 06
OutCue:
Contents: Napton says that the big problem is m-o-n-e-y.

But even the biggest supporter of HMO's thinks money can be a problem.

Mexico resident Jack Napton has been in one of the nations largest HMO's, Kaiser Permanente, for over fourty years.

Every three months Jack makes the two and a half hour trip Kansas City to get his health care.

But he says it's worth it.

He had a triple-by-pass about fifteen years ago, at a time when procedures like that weren't very common.

He's also had a lot of other major operations, but through all of them he says Kaiser has been wonderful.

Actuality:
RunTime: 15
OutCue:
Contents: Naptopn says he had wonderful treatment and never saw a bill.

Even in a day when the kind of care people saw on Marcus Welby is considered over by most, Jack still has a great relationship with his doctor.

Actuality:
RunTime: 19
OutCue:
Contents: Napton says he has a lot of rapport with his doctor and even knows that her new daughter is red-headed.

But rapport isn't something that most critics say is possible between a doctor and a patient-- when an HMO is involved.

For KBIA's Capitol Edition, I'm David Freitas.