Getting cancer at age 19 was bad enough. Then, a year and a half into his five-year treatment plan, Erich McGilvreay was told by his family's new insurance company that he had to switch doctors.
McGilvreay's experience with managed care is the kind of story that has New Hampshire legislators debating a bill of rights for patients. Public hearings on three bills were held last week in Concord, N.H.
"My doctor knew me-he could see in a test if I had eaten a bagel," McGilvreay, now 23, told the Concord Monitor last week. "And it's Dana-Farber-cancer is what they deal with every day. I just didn't feel the same confidence level with (the hospital in) Manchester."
McGilvreay went to the renowned Dana-Farber Cancer Institute in Boston after learning he had testicular cancer. After an operation to remove the tumor, a specialist prescribed a five-year series of tests and blood work.
When his mother's employer-the state of New Hampshire-switched insurers, McGilvreay came face to face with managed care. His new "gatekeeper" doctor was reluctant to let him continue treatment at Dana-Farber, saying a Manchester hospital could do the tests just as well.
But McGilvreay's mother, Pam Merkwan, didn't trust the doctor to make that decision. That's because the family's insurance plan, Blue Choice, sometimes penalizes doctors for referring patients outside its network.
McGilvreay got his referral in the end but was told to find another primary caregiver.
"When you see a doctor, you should feel comfortable," Merkwan said. "The problem with the HMOs is that the doctor is no longer your advocate-he's the insurance company's employee."
Like other managed-care programs, Blue Choice, a program of Blue Cross and Blue Shield of New Hampshire, tries to reduce costs by contracting with doctors to provide services at a discount. It also monitors care to try to see that patients get adequate care, but not unnecessary care.
The problem is that when their health is at stake, people are not happy about having their freedom to choose restricted.
"As a company, or even as an industry, we can do anything people want us to," said Clark Dumont, a Blues spokesman. "But people have to be willing to pay for it."