HEAL THYSELF

By Andrew J. McClurg

Legal disputes arising from denial of medical coverage by managed health
care organizations are on the rise. HMO's face a difficult challenge in
making coverage decisions because they must delicately balance two
conflicting interests: providing quality health care for their patients at a 
reasonable cost and hoarding as much money as possible. Here are some of the 
more common questions about coverage and some standard responses from HMOs.

Q: How do I know whether my condition is covered?
A: Check the "exclusions" section of your plan description.  Typical
services excluded from coverage include dental care, cosmetic surgery and
anything costing more than $10. Our preferred method for determining
whether a condition is covered is through an autopsy.  However, before
seeing a coroner you must get a referral from your primary care physician.

Q: Is mental health treatment covered?
A: Are you crazy? That stuff is expensive.  However, to serve the mental
health needs of our loyal plan participants, we've set up a therapy help
line.  Simply dial our toll-free number and select from the following menu 
of sensitive pre-recorded treatments: 1) Quit Your Whining. 2) It's Your 
Mother's Fault. 3) Dump The Jerk. 4)Those Strange Voices In Your Head Aren't 
Real. 5) Smiling Your Way Through Deep, Dark Depression.

Q: Is Viagra covered?
A: Only under the extended plan.  Ha - kidding!  The real answer is: no.
Due to rising pharmaceutical costs, we've been forced to make minor
adjustments in our prescription coverage.  Effective immediately, the
following prescriptions are no longer covered: the most popular drugs
selected by physicians for effective treatment of the most common ailments 
suffered by human beings.

Q: How can I get in to see an "out-of-network" provider as described in my 
plan?
A: You can't.  that's a typo. The coverage is for "out-of-work" providers. 
They're much cheaper.

Q: What happens if coverage is denied but I desperately need treatment?
A: We recognize the need to resolve coverage disputes expeditiously.  For
this reason we've established a speedy, automated appeal procedure.  Step
one: Request EZ Complaint From 5436. Step two: Complete all 72 pages,
including attached "Humiliating Intrusion into Your Personal Life and
Medical History Form 7435".  Step 3: Conveniently deposit the completed
form in any nearby trash receptacle.  while you relax in the comfort of
your home, your claim is being automatically processed and denied.

Q: I'm blind.  Does your company show special sensitivity in handling
claims by the sight impaired?
A:

Q: My plan excluded coverage for pre-existing conditions.  What does that
include?
A: The new industry-wide definition for pre-existing condition is: "Any
illness, disease, infirmity, malady, affliction, ailment, injury, sore
through, cough, fever, infection, scraped knee, broken bone, pregnancy,
concussion, psychosis, kidney stone, tumor, hemorrhage, missing limb, ache, 
pain or gripe of any kind arising on or before the date on which medical 
treatment is sought."

Q: Does my plan cover home visits by a designated provider?
A: Ha, ha, ha, ha, ha, ha, ha, ha, haž stop, you're killing me.