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HMO Blues

Question:

I’ve been diagnosed as bipolar and probably have what they refer to as hypo manic episodes on a fairly regular basis. I’m treated w/500mg of Depakote 4xday(2 of those at bedtime). I also take 20mg of Pozac in the a.m. for depression. I also don’t sleep-day or night and this is incredibly difficult to deal with most of the time. I also suffer severe anxiety attacks and am treated with .5mg of Diazapam 3xday(most of these kind of med’s. make me ill.). And, the coup de graus is I’m bulemic, 4-5x daily. I’m not undergoing any psycholical help, my doctor didn’t recommend it as necessary(HMO). She did think I should be hospitalized at one point but didn’t pursue it. Any suggestions for this women who is a mess. I hate being so medicated. I don’t really notice any real normalicy)whatever that may be…. I will appreciate your feedback.

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Answer:

Keep in mind what an HMO is. An HMO (Health Maintenance Organization) is a for-profit, publicly owned company (most of the time) who is motivated not to make you well – but to maintain your health at a minimally acceptable level. The HMO wants to spend as little money on you as they can get away with. They are not motivated at all to make you as well as you could be – but only to keep you from being damagingly (and expensively) unhealthy. HMO’s control the money flow into a doctor’s pocket. Therefore – if a doctor wants to keep up his or her lifestyle (and they do) they learn to do the HMO’s bidding – which means that they learn not to recommend any “unnecessary” treatments. I don’t mean to bash at the HMOs too much. Something like the HMO rationing system is necessary – because no nation in this world has enough resources to provide the BEST care to EVERYONE who needs it. It is just that the definition of “minimal care” often is heavily weighted in favor of medical treatments and mental health treatments tend to be massively underfunded. You are not helpless in the face of your HMO’s/Doctor’s decision that you don’t need additional care. You can learn to speak up for yourself – to become an advocate for your own care. Organizations like HMOs do often respond to the needs of “squeaky wheels”; they ignore all silent voices. Advocating for yourself may involve making your desires for greater treatment perfectly clear to your doctor, asking the HMO for a different primary care physician, and/or writing letters to the officers of the HMO. Be careful to not get angry during this communication – you will be best off being firm and polite but insistent. Most particularly they need to know you are bulimic. Bulimia is a dangerous condition that requires medical and psychological/behavioral help and can (when purging/vomiting continues over time) can result in severe physical damage and can even be life-threatening in some cases.

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