With all the abuse heaped on HMOs for denying patients access to care, one managed-care executive has found a new culprit for patients to blame.
Often, it's the capitated physician group, not the HMO, that is restricting access to a specialist or denying payment for emergency room visits, says Marshall Rozzi, president and chief executive officer of United HealthCare of Illinois, Chicago. Providers wanted more control of patients to protect their market share, but many are being disingenuous with patients about the extent of their power, he claims.
"I think providers are being honest when they say (restricting patient care) is part of their contract with the HMO," Rozzi says. But "it's easy to sidestep criticism without saying that (physician groups) wanted it that way."