What would happen if you needed health
by Metro Seniors in Action - A Chicago Coalition
By now you have heard the horror stories about some managed
health care organizations such as HMOs. For example, Wanda Peake was told by
her managed care organization that it would not pay to save her leg, but
only to cut it off, since amputation was the least expensive
"treatment" ("Medicine aches with HMO fever", Chicago Tribune,
April 14, 1996, Page 1).
We may not be in a managed care organization, or in one that would treat us
like that. Nevertheless, more and more people are being pushed or lured into
such organizations. A managed care organization that today serves us well
tomorrow may be taken over by forces more interested in money than in
people's health. The takeover trend is strong, with more managed care groups
organizing for profit. Such organizations, by their nature, get to keep more
of our money when they delay or deny care for our health. They get a fixed
amount of money, whatever our needs, and what they don't spend of that
amount on our health, they keep.
Metro Seniors in Action is a Chicago coalition of some 125 organizations
with 10,000 members advocating affordable, quality health care for all. As
one step toward this goal, Metro Seniors in Action proposes a Chicago
Managed Care Consumer Protection Ordinance. This ordinance would
Although the need for such protections as these is statewide and
nationwide, Metro Seniors in Action considers it
dangerous to wait for state or federal action, and has gathered written
legal opinions supporting Chicago's authority to pass this ordinance.
- Ban managed care organization gag rules on doctors. The ban would free
doctors to tell patients about all treatment possibilities, not just those
the managed care organization favors.
- Require managed care organizations to authorize or deny payment for care
based on generally accepted medical standards,
- Allow denial of case only by a medical professional who has examined
- Assure the patient can seek a second opinion outside the managed care
organization, as a covered benefit.
- Require managed care organizations to disclose where the money goes
(advertising, profits, etc.).
- Require a grievance procedure that is clear to patients.
Metro Seniors in Action is finding support for this ordinance in City
Council, and members of the Daley Administration are reviewing the
ordinance. Support of individuals and groups for this ordinance is important
and very welcome. The ordinance already has been endorsed by organizations
- Illinois Citizen Action (formally Illinois Public Action
- Access Living
- Campaign for Better Health Care
- United Electrical Workers District 11
- Physicians for a National health Plan, Illinois Chapter
- Illinois State Council of Senior Citizens
- American Association of Retired Persons (AARP) Chapter 3285
- AFSCME Retirees, Chicago Chapter. (American Federation of State, County
and Municipal Employees)
- SSI Coalition
- ATU (Amalgamated Transit Union) Local #308
- National Organization of Women, Chicago Chapter
Besides group and individual endorsements, Metro
Seniors in Action also is looking for reports from people whose
health care they have delayed or denied by managed care organizations
for financial reasons. Your story is important!
To share your story, your support or any other comments
or questions, please write call or fax.
Metro Seniors In Action
220 S. State Street
Chicago, Il 60604
Tel.: (312) 341-4733
Fax: (312) 341-9847