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Discussion

Nursing Student Needs Help!!

Hello there everyone!

I logged on to the site here as a last resort for help with an assignment I have. I figured getting some feedback from nurses would be great. I have to discuss one major current issue or trend that has had an impact on the development of the nursing profession. I thought I would write about the problems arising today due to HMO's and DRG's. Do any of you nurses feel any repercussions of the insurance issues today? Do you feel your patient care is affected in any ways? If so please reply with your comments. If not, any other issues you face today?

Thanks a bunch!!

Amy

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  • Experts

Some sources of info: case management, nursing homes and long-term care, home care equipment. That should be enough to get you started. I'm an outpatient ER case manager and yes, HMOs and even to a degree DRGs do definitely affect the care that we provide. Good luck...judi

HMO's are crap. Sorry to be so blunt, but that's the way it is. They look for ways to give the cheapest "care" possible. They set limits as to what kind of tests and/or procedures you can have. They require a gatekeeper to keep patients from going to specialists of their own accord and reward physicians under the table for not ordering high-cost tests or multiple referrals. Their brightest achievement is the recent ruling that prevents them from being sued for refusing to cover a service. In other words, if you need a procedure that is not covered and you suffer complications or die because you did not get said procedure, the HMO cannot be sued by you or your survivors. What they say you are to do is to pay for the procedure and then sue the HMO for the cost of the procedure (key here is NO PUNITIVE DAMAGES). Well, that's great if you have $75,000 laying around your house and it assumes that you will win your lawsuit later on.

Try doing a search on legislation regarding suing your HMO. You could find more details about the ruling.

  • Author

Thank you so much for your feedback! Being a pre-nursing student, I do not get to see these effects on the patient's. I appreciate your first-hand opinion. :)

HMO's are crap. Sorry to be so blunt, but that's the way it is. They look for ways to give the cheapest "care" possible. They set limits as to what kind of tests and/or procedures you can have. They require a gatekeeper to keep patients from going to specialists of their own accord and reward physicians under the table for not ordering high-cost tests or multiple referrals. Their brightest achievement is the recent ruling that prevents them from being sued for refusing to cover a service. In other words, if you need a procedure that is not covered and you suffer complications or die because you did not get said procedure, the HMO cannot be sued by you or your survivors. What they say you are to do is to pay for the procedure and then sue the HMO for the cost of the procedure (key here is NO PUNITIVE DAMAGES). Well, that's great if you have $75,000 laying around your house and it assumes that you will win your lawsuit later on.

Try doing a search on legislation regarding suing your HMO. You could find more details about the ruling.

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