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Dear Friends,
One week ago my husband's company gave us two weeks to decide whether we
would keep our current health coverage with steep financial penalties, or
switch to managed care. With the latter we would need to select primary care
physicians from their list.
   I called the office of a doctor who appeared to be a good choice after
some informal research. She is a member of a highly respected group at one of
the most highly respected hospitals in the Boston area. My questions revealed
they do not give introductory appointments and all referrals are only to
doctors in the same hospital.
   Now, my allergist, the wonderful Dr. Stuart Rhein who diagnosed my cd, is
at Metrowest; my terrific gynecologist is at Brigham and Women's; and the
world-renowned doctor who helped me avoid an unnecessary biopsy and does my
yearly mamogram is at The Faulkner.
   The only reason I can see for all referals to be made within the hospital
is financial gain. I've also heard rumors that HMOs pay cash awards to their
doctors when they do some things that save the HMO money but may not be in
the client's best interest.
   Is this old hat? I am outraged. Are you?
   You can guess how I feel about not being allowed to talk to a new doctor.
Maybe I will make an appointment for something minor that wouldn't usually
send me to a doctor, in order to meet her. (At the risk of being labeled a
hypochondricac! ... all those years of being told the pain that made me wish
I were dead and turned out to be cd, something perfectly avoidable, was all
in my head....) And I will pay extra to continue seeing my regular
specialists. I wonder what happens to people who can't afford to pay extra.

Mara in MA, USA