Will Medicare HMO patients receive less treatment after having heart attacks?

According to a study published in the New England Journal of Medicine's issue, top-quality medical treatment are not being offered to Medicare HMO customers with heart problems and other heart-related medical issues.

Here are some statistics of the study: (These evaluations are made based on the examination of records from 50,000 heart attack patients from seven states)

• 46 percent of fee-for-service patients received a post-heart-attack test that determines blood flow levels through arteries

• 37 percent of managed-care patients received the test

Patients admitted to hospitals without angiogram facilities had follow-up rates that were lower for both groups this time:

• 31 percent of fee-for service patients
   
• 15 percent of managed-care patients

The study concludes, "In situations where angiography is thought to be useful, it is used less often among Medicare beneficiaries enrolled in managed-care plans that among those with fee-for-service coverage.'

In order to determine whether there are certain gaps in patient care, managed care plans will use the study's conclusions, according to Susan Pisano, spokesperson for the American Association of Health Plans (AAHP), a national HMO trade group. Nevertheless, the study shows that care is lacking for heart patients for both groups - HMOs and traditional fee-for-service plans.

Pisano claims, "We frequently are asked, don't you have an incentive to withhold this kind of care. No. Withholding treatment that could help prevent a second heart attack is not only the wrong thing for the patient, but it would mean greater expenses for HMOs down the line.'

If you think that you aren't getting the coverage that you should be getting, that doesn't mean that you should keep quiet about it. Keep in mind that if you don't contact your health insurer and tell him or her about what is going on and what you should be getting, you might end up with little or not enough coverage. If you realize now that you don't' have enough coverage on your plan, consider the following tips:

• Negotiate with your health insurer for a better coverage plan

• If you see that you already purchased all the necessary coverage, but aren't getting it, you might want to consider shopping around for another policy

• If you receive a bad response, or if you find out that the coverage that you are paying for is not provided for you, you might want to contact your attorney and see what you should do next