What would happen if you needed health care?

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

  1. 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.

  2. Require managed care organizations to authorize or deny payment for care based on generally accepted medical standards, despite costs.

  3. Allow denial of case only by a medical professional who has examined the patient.

  4. Assure the patient can seek a second opinion outside the managed care organization, as a covered benefit.

  5. Require managed care organizations to disclose where the money goes (advertising, profits, etc.).

  6. Require a grievance procedure that is clear to patients.

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.

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 that include:

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
Suite 730
Chicago, Il 60604
Tel.: (312) 341-4733
Fax: (312) 341-9847