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Have you had a problem with an insurance plan? Tell the Dallas County Medical Society about it! Send comments and questions to tracy@dallas-cms.org. In your e-mail, include your name, contact information, name of your plan, and a brief description of your problem and/or question. You can also forward information by fax (214-946-5805) or by mail (PO Box 4680, Dallas TX 75208, ATTN: Patient Advocacy Program). We'll forward your information to the Texas Department of Insurance, or you can send the TDI a copy: Jose' Montemayor, TDI Commissioner, PO Box 149104, Austin TX 78711. The HMO Hotline at the TDI is 1-800-252-3439.
People who have encountered problems with their managed care health insurance plans have an outlet to voice their concerns and perhaps bring about change in the laws that govern HMOs (health maintenance organizations). In response to numerous complaints and concerns patients have voiced regarding their managed care health insurance plans, the Dallas County Medical Society began its Patient Advocacy Program.
"Patients are frustrated and haved asked for our help," James L. Sweatt III, MD, DCMS past president, said in announcing the program. "Patients are suffering under managed care; we want to help patients regain control of their health care. HMOs are denying patient choices and have too much control over patient care. Under managed care, patients can't be seen when they want, at the hospitals they want, and by the specialists they want."
Dr. Sweatt, a thoracic surgeon, also encourages physicians to participate in the program, which provides them another means to act as advocates for their patients. "Physicians - not managed care companies - are the most reliable guardians of health care," he said, "Health care needs to return to being patient focused, not bottom-line focused."
The medical society plans to cite the accumulated stories in discussions with state legislators and congressmen, in hopes of educating lawmakers about problems with managed care. Patients may be asked to testify before the Texas Legislature about their experiences. The complaints will also be made known to the Texas Department of Insurance, chambers of commerce, and city councils.
"If people have active, live complaints, maybe we can help solve them," Dr. Sweatt said. "If we as physicians had the power to independently correct every problem, we would. But compiling patients' experiences will help us plead their cases before Congress and the Texas Legislature."
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